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Practice Lesson of the Week

Hypothyroidism in a patient with non-alcoholic fatty liver disease

BMJ 2011; 342 doi: (Published 06 January 2011) Cite this as: BMJ 2011;342:c7199
  1. CJ Gardner, clinical research fellow1,
  2. P Richardson, consultant gastroenterologist2,
  3. C Wong, clinical research fellow1,
  4. N Polavarapu, specialist registrar3,
  5. GJ Kemp, reader4,
  6. DJ Cuthbertson, senior lecturer and honorary consultant endocrinologist1
  1. 1Diabetes and Endocrinology Clinical Research Unit, University Hospital Aintree, Liverpool L9 7AL, UK
  2. 2Department of Hepatology, Royal Liverpool University Hospital, Liverpool L7 8XP
  3. 3Department of Gastroenterology, University Hospital Aintree, Liverpool L9 7AL
  4. 4Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, L69 3GE
  1. Correspondence to: D Cuthbertson daniel.cuthbertson{at}
  • Accepted 9 November 2010

Consider hypothyroidism as a cause of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease is increasingly recognised as a cause of chronic liver disease (affecting in some series 30-40% of the population1) and the commonest cause of abnormal liver function tests. The disease spans a spectrum of histopathological abnormalities, ranging from simple hepatic steatosis and steatosis with necroinflammation to steatosis with necroinflammation accompanied by varying degrees of fibrosis (which may progress to cirrhosis and its complications, including liver failure and hepatocellular carcinoma).2

Non-alcoholic fatty liver disease is characterised by a bright liver echo pattern on abdominal ultrasonography, and although it is often accompanied by raised liver enzymes, in many cases liver biochemistry is normal.3 Most patients are asymptomatic, with liver disease identified incidentally from abnormalities discovered in routine biochemistry tests or imaging performed for other reasons.

Although obesity is the commonest and primary metabolic cause, non-alcoholic fatty liver disease may arise secondary to several other endocrine disorders, including thyroid dysfunction, growth hormone deficiency, adrenal insufficiency, and polycystic ovary syndrome.4 It is important to consider and screen for underlying conditions in the diagnostic approach to non-alcoholic fatty liver disease.

We report the case of a young man diagnosed with non-alcoholic fatty liver disease in whom an underlying cause was discovered.

Case report

A 33 year old, previously healthy man presented to his general practitioner with a hot swollen ankle of recent onset. He had no other joint involvement and no systemic symptoms apart from general lethargy, which he attributed to his shift work. He did not drink alcohol and was not taking any prescribed medication or over the counter drugs. He had a history of untreated obstructive sleep apnoea. His general practitioner diagnosed gout and recommended treatment with non-steroidal anti-inflammatory drugs but arranged to check renal function and liver …

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