Correlation Between the Thyroid Hormone Levels and Type 2 Diabetes Mellitus in Non-Alcoholic Fatty Liver Disease.

PubMed1 Jan 2026·Diabetes, metabolic syndrome and obesity : targets and therapy● 3/10i

Correlation Between the Thyroid Hormone Levels and Type 2 Diabetes Mellitus in Non-Alcoholic Fatty Liver Disease.

Bian L, Fan H, Yu Q, Rao X, Tang T et al.

The FT3/FT4 ratio shows moderate discriminatory performance for type 2 diabetes in patients with NAFLD, with those in the highest quartile having 73% lower odds of diabetes (OR 0.27). Retrospective analysis of 4,942 hospitalized patients with NAFLD at one Chinese center, 2020-2023. This provides the first evidence that thyroid hormone ratios could serve as metabolic risk markers in NAFLD populations, potentially offering a novel biomarker approach. Single-center Chinese data may limit generalizability to other populations.

Strategic signal

This biomarker research creates no immediate commercial impact but adds to the growing evidence base linking thyroid function to metabolic disease. The moderate discriminatory performance (AUC 0.668) falls short of clinical utility thresholds typically required by regulatory bodies like FDA for diagnostic claims. The finding may influence future metabolic drug development strategies by highlighting thyroid-liver-diabetes interconnections, particularly for companies developing NAFLD therapies who could incorporate thyroid monitoring into their clinical programs.

Type 2 diabetesLiver/NASH

Original Abstract

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are significant metabolic disorders that frequently coexist and share interrelated pathophysiological mechanisms. Thyroid hormones (THs) play multifaceted roles in metabolic regulation. This study explored the association between THs-particularly the free triiodothyronine (FT3) to free thyroxine (FT4) ratio (FT3/FT4)-and T2DM among NAFLD individuals. PATIENTS AND METHODS: A total of 4942 patients with NAFLD hospitalized at the Affiliated Hospital of Hangzhou Normal University between 2020 and 2023 were retrospectively analyzed. Partial correlation analysis controlling for age and sex was conducted to investigate the relationships between THs and the FT3/FT4 ratio with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) in NAFLD patients with T2DM. Meanwhile, the association between the FT3/FT4 ratio and T2DM was assessed by binary logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminatory ability of the FT3/FT4 ratio for T2DM. RESULTS: Patients with T2DM had significantly lower FT3, TT3, and the FT3/FT4 ratio, while higher FT4, compared with those without. Partial correlation analysis further showed the negative correlation of FT3, TT3, and the FT3/FT4 with HbA1c and FBG, with the FT3/FT4 ratio showing the strongest correlation with HbA1c (r = -0.222, p < 0.001). After adjusting for confounding factors, individuals in the highest FT3/FT4 quartile had a markedly reduced likelihood of T2DM relative to those in the lowest quartile (OR 0.27, 95% CI 0.23-0.33; p < 0.001). ROC analysis showed a moderate discriminatory performance of the FT3/FT4 ratio for T2DM (AUC up to 0.668). CONCLUSION: In patients with NAFLD, a lower FT3/FT4 ratio was significantly associated with T2DM and poorer glycemic status. Compared with individual TH levels, the FT3/FT4 ratio may serve as a more integrative marker of metabolic risk in this population.

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