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Abstract Metabolic associated fatty liver disease (MAFLD) is a clinical pathological syndrome and one of its key characteristics is hepatic steatosis which can be caused by excessive accumulation of fat in the liver, The criteria of (MAFLD) are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic disorders. The disease spectrum includes Metabolic associated steatosis (MAS), Metabolic associated steatohepatitis (MASH), liver fibrosis and liver cancer. A meta-analysis of 35,599 patients with type 2 diabetes mellitus (T2DM) from 6 countries indicated that the prevalence of MAFLD was 59.67%. Metabolic associated fatty liver disease (MAFLD) can significantly increase the prevalence of chronic complications in patients with T2DM, on the other hand, T2DM can stimulate the development from MAFLD to MASH and make it easy to progress to liver fibrosis. Nowadays, liver biopsy is the “gold standard” in diagnosing MAFLD and progressive liver disease. However, liver biopsy is an invasive approach, so Angulo et al. recommended the use of MAFLD liver fibrosis score as preliminary evaluation of liver fibrosis is a non-traumatic liver fibrosis scoring system and MFS > 0.676 is usually used as marker of progressive liver fibrosis. These patients with MFS > 0.676 are prone to progression of cirrhosis or even liver cancer while MFS < -1.455 is the exception to progressive liver fibrosis. However, MFS is rarely investigated in T2DM patients, and most studies were based on the use of color ultrasound which can only identify AFLD with liver fat content greater than 30%. Zhang et al. pointed out that the liver fat content of T2DM patients decreased while the liver fibrosis score was higher in these patients, suggesting that the use of liver color ultrasound diagnosis may underestimate the occurrence of MAFLD. Therefore, it is necessary to find other strategy for effective assessment of MAFLD in T2DM patients. The liver plays a crucial role in the metabolism of cholesterol and triglycerides (TG). Meanwhile, thyroid hormones interact on hepatic lipid homeostasis through multiple pathways, including stimulation of free fatty acid delivery to the liver for reesterification to TG, and increasing fatty acid β-oxidation, thereby affecting hepatic fat accumulation. Lower thyroid hormone level can increase blood lipids and increase the prevalence of MAFLD. Byrne et al. pointed out that hypothyroidism was a key element for the occurrence of MAFLD. In contrary, Lee et al. pointed out that hypothyroidism was not correlated with the occurrence of MAFLD. Van den Berg et al. studied people with normal thyroid function and concluded that the free triiodothyronine (FT3) of MAFLD patients was very high, and free thyroxine (FT4) was very low. Kim et al. found subclinical hypothyroidism was one of the independent factors for progressive liver fibrosis. Recent studies indicated an association between thyroid hormone and liver level of triglyceride in T2DM patients. These studies suggested the necessity to clarify the relationship between thyroid hormones with MAFLD, particularly for these T2DM patients the association between the thyroid hormones and Metabolic associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM) Egyptian patients is not clear yet. The objective of this study was to analyze the association between the thyroid hormones and Metabolic associated fatty liver disease (MAFLD) in type 2 diabetes mellitus (T2DM) Egyptian patients. |