Thyroid Function and Non-alcoholic Fatty Liver Disease in Children and Adolescent With Obesity: A Systematic Review and Meta-Analysis.
Elisa Gatta, Massimiliano Ugoccioni, Elena Gandossi et al.
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In 30 seconds
This systematic review and meta-analysis examined thyroid function in children and adolescents with obesity, comparing those with and without non-alcoholic fatty liver disease (NAFLD). Ten observational studies included 5,145 participants. Across six studies (3,076 participants), TSH was higher in the NAFLD group, with a mean difference of 0.37 mIU/L (95% CI 0.07-0.66). Free thyroxine and free triiodothyronine did not differ significantly between groups. The findings indicate an association between NAFLD and higher TSH, but do not establish causality.
Key findings
- Across six studies (n= 3076), TSH was higher with NAFLD: mean difference 0.37 mIU/L; 95% CI 0.07-0.66.
- Free thyroxine did not differ significantly between groups (standardized mean difference -0.35; 95% CI -1.15 to 0.45).
- Free triiodothyronine did not differ significantly between groups (standardized mean difference 0.35; 95% CI -0.26 to 0.96).
- The TSH association was robust in sensitivity analyses; heterogeneity was moderate (I 2 = 48.7%).
Why it matters
In children and adolescents with obesity, higher TSH may accompany hepatic steatosis even when circulating thyroid hormone concentrations are not significantly different. This association may help frame interpretation of thyroid tests in this population, but the evidence does not show that TSH causes NAFLD or establish its value for diagnosis or management.
What to keep in mind
The evidence comes from observational studies, so it cannot establish causality. The authors note that prospective studies are needed to clarify clinical implications.