J Korean Med Sci.  2021 May;36(20):e137. 10.3346/jkms.2021.36.e137.

Severe Phenotype of Non-alcoholic Fatty Liver Disease in Pediatric Patients with Subclinical Hypothyroidism: a Retrospective Multicenter Study from Korea

• Choi SY
• Yi DY
• Kim SC
• Kang B
• Choe BH
• Lee Y
• Lee YM
• Lee EH
• Jang HJ
• Choi YJ
• Kim HJ

• KMID: 2516049
• DOI: http://doi.org/10.3346/jkms.2021.36.e137

Abstract

Background
It is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with subclinical hypothyroidism (SH) in pediatric patients. The purpose of this study was to investigated the prevalence and related factors of SH in pediatric patients with NAFLD. We also evaluate the association between liver fibrosis and SH.
Methods
We retrospectively reviewed medical records for patients aged 4 to 18 years who were diagnosed with NAFLD and tested for thyroid function from January 2015 to December 2019 at 10 hospitals in Korea.
Results
The study included 428 patients with NAFLD. The prevalence of SH in pediatric NAFLD patients was 13.6%. In multivariate logistic regression, higher levels of steatosis on ultrasound and higher aspartate aminotransferase to platelet count ratio index (APRI) score were associated with increased risk of SH. Using receiver operating characteristic curves, the optimal cutoff value of the APRI score for predicting SH was 0.6012 (area under the curve, 0.67; P < 0.001; sensitivity 72.4%, specificity 61.9%, positive predictive value 23%, and negative predictive value 93.5%).
Conclusion
SH was often observed in patients with NAFLD, more frequently in patients with more severe liver damage. Thyroid function tests should be performed on pediatric NAFLD patients, especially those with higher grades of liver steatosis and fibrosis.

Keyword

Non-alcoholic Fatty Liver Disease; Subclinical Hypothyroidism; Liver Steatosis; Liver Fibrosis

Figure

• 

  Fig. 1 APRI score, a noninvasive marker of liver fibrosis, was significantly higher in patients with SH than in those with euthyroidism.APRI = aspartate aminotransferase to platelet count ratio index, SH = subclinical hypothyroidism.

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  Fig. 2 Receiver operating characteristic curves of APRI to predict subclinical hypothyroidism.APRI = aspartate aminotransferase to platelet count ratio index.

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