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April 19, 2026Diabetes Metabolic Syndrome and Obesity0 citationsOpen Access

Association Between Thyroid Hormone Sensitivity Indicators and Controlled Attenuation Parameter (CAP) Values in Euthyroid Adults with Overweight/Obesity

YZYifang Zhang CBCuiping Bao LLLingling Liu

Key Points

The aim is to examine the relationship between thyroid hormone sensitivity indicators and hepatic steatosis in adults with overweight/obesity.
Evaluated thyroid sensitivity using indices like TFQI FT3 and FT3/FT4 ratio.
Diagnosed hepatic steatosis using vibration-controlled transient elastography.
Utilized linear regression, logistic regression, and restricted cubic spline regression for analysis.
Conducted mediation analysis to assess liver enzyme and lipid impacts on associations.
Severe hepatic steatosis group showed higher levels of TFQI FT3 and FT3/FT4 ratio compared to non-severe group.
Significant increase in TFQI FT3 (β = 25.38) and FT3/FT4 ratio (β = 210.92) with CAP after adjustments.
Associations remained significant across analyses, not mediated by blood lipids or liver enzymes.

Abstract

Background: Obesity is an established contributor to hepatic steatosis. Despite weight control efforts, the incidence of steatosis and its associated hepatic complications continues to increase, highlighting the critical need to identify obesity-related pathogenic mechanisms for developing effective therapeutic strategies. Aim: This study aims to explore the association between thyroid hormone sensitivity indicators and hepatic steatosis assessed by controlled attenuation parameter (CAP) values in euthyroid individuals with overweight/obesity. Methods: Sensitivity to THs, was evaluated using TFQI FT3 , TFQI FT4 , TSHI, TT4RI, TT3RI, and FT3/FT4 ratio. Hepatic steatosis was diagnosed via Vibration-controlled Transient Elastography (VCTE). Linear regression, binary logistic regression, and restricted cubic spline regression (RCS) were used to analyze the associations between these composite indices and CAP levels. Bayesian mediation analysis was performed to assess the mediation effect of liver enzymes and lipids on the relationship between sensitivity parameters to THs and CAP. Results: Compared to the non-severe hepatic steatosis group, the severe hepatic steatosis group exhibited significantly higher levels of TFQI FT3 , and FT3/FT4 ratio (all P < 0.05). After adjustment for multiple risk factors, TFQI FT3 (β = 25.38, 95% CI 10.21– 40.55) and the FT3/FT4 ratio (β = 210.92, 95% CI 116.37– 305.47) increased with CAP (P< 0.001), but not in TFQIFT4 (p = 0.071). These associations remained significant in binary logistic regression analysis and RCS. Further mediation analysis and subgroup analysis showed that the correlation was not mediated by blood lipid and liver enzyme impairment, and remained stable across all subgroups. Conclusion: The correlation between TH sensitivity and hepatic steatosis was significantly stronger in TFQI FT3 than in TFQI FT4 . TFQI FT3 and the FT3/FT4 ratio can be used as new indicators for predicting hepatic steatosis in individuals with overweight/obesity. Keywords: obesity, thyroid hormone sensitivity, hepatic steatosis, TFQI, FT3/FT4 ratio

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