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Narative Review Volume 14 Issue 2
The thyroid-liver axis in metabolic dysfunction-associated steatotic liver disease: a narrative review
Girin Ray, Debmalya Sanyal
Received: March 14, 2026 | Published: April 3, 2026
Citation: Sanyal D, Ray G. The thyroid-liver axis in metabolic dysfunction-associated steatotic liver disease: a narrative review. Endocrinol Metab Int J. 2026;14(1):27-31. DOI: 10.15406/emij.2026.14.00386
Abstract
Objective: To review the epidemiological and pathophysiological associations between
hypothyroidism and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD),
alongside evaluating novel thyromimetic therapies.
Methods: A concise narrative review of the literature regarding systemic thyroid function,
MASLD severity, and liver-directed thyroid hormone receptor-beta (THR-beta) agonists.
Results: Epidemiological data show a significantly higher prevalence of MASLD in
populations with both overt and subclinical hypothyroidism, a risk heavily compounded
by concurrent metabolic syndrome. Mechanistically, thyroid hormones orchestrate
hepatic lipid homeostasis; their localized functional deficiency within the liver (“hepatic
hypothyroidism”) actively drives steatogenesis and fibrogenesis. Liver-directed THR-beta
agonists demonstrate breakthrough efficacy in resolving metabolic steatohepatitis (MASH)
and improving fibrosis.
Conclusion: The bidirectional thyroid-liver axis operates as a pivotal driver of MASLD
pathogenesis. Correcting states of hepatic hypothyroidism through targeted THR-beta
agonism represents a clinically validated, disease-modifying therapeutic strategy.
Keywords: thyroid-liver, epidemiological, metabolic dysfunction, steatotic liver
©2026 Sanyal, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.