Thyroid function and liver fibrosis: FT3 levels are inversely and independently correlated with enhanced liver fibrosis score in solid organ transplant patients with dysglycemia

Background: Solid organ transplantation (SOT) is frequently complicated by dysglycemia and metabolic dysfunction-associated steatotic liver disease (MASLD), conditions that accelerate the development of liver fibrosis. Given the recognized thyroid-liver crosstalk, we investigated the association between thyroid function and the enhanced liver fibrosis (ELF) score in SOT recipients with diabetes or prediabetes. Methods: Seventy-one adult SOT recipients with diabetes or prediabetes, with ultrasound evidence of liver steatosis and/or a FIB-4 > 1.3, underwent standardized clinical phenotyping, biochemical profiling, thyroid hormone measurements, ELF testing, and liver stiffness measurement (LSM). Associations with ELF were assessed using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index (BMI), transaminases, glycated haemoglobin, creatinine, haemoglobin, albumin, immunosuppressive drugs, glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, and transplanted organ type. Results: Participants had a mean age of 63.1 ± 9.5 years and BMI of 27.8 ± 4.8 kg/m². Mean ELF was 9.21 ± 1.00 (low risk