Key result
Heart failure in MASLD is linked to ~13-point higher prevalence of low T3 syndrome.
Why the study?
The relationships between low triiodothyronine syndrome and metabolic disorders, hepatic steatosis and fibrosis, and heart failure severity in patients with metabolic dysfunction-associated steatotic liver disease needed investigation.
Cross-Sectional (n=127)
In patients with comorbid MASLD and heart failure, low T3 syndrome is a frequent manifestation that correlates negatively with both liver fibrosis stage and NYHA functional class, potentially serving as a marker of disease severity.
Objective — to investigate the relationships between low triiodothyronine syndrome (low T3 syndrome) and metabolic disorders, the degree of hepatic steatosis and fibrosis, as well as the severity of heart failure (HF) in patients with metabolic dysfunction‑associated steatotic liver disease (MASLD). Materials and methods. 127 patients with MASLD were examined: 83 individuals with comorbid HF (main group) and 44 individuals with isolated MASLD (comparison group). Anthropometric data were studied; body composition was assessed using the OMRON BF‑511 body composition monitor. Lipid and carbohydrate metabolism parameters, as well as thyroid hormone levels, were determined via enzyme‑linked immunosorbent assay (ELISA). Hepatic steatosis and fibrosis were diagnosed using ultrasound on the Soneus P7 system with elastography and steatometry functions. Doppler echocardiography was performed using the VIVID‑3 ultrasound diagnostic system. Results. Low T3 syndrome (fT3 < 3.0 pmol/L) was identified in 31.3% of patients in the main group compared to 18.2% in the comparison group. Patients with low T3 syndrome exhibited significantly higher body mass index (BMI), visceral fat percentage, triglycerides, and HOMA‑IR levels (p<0.05). A moderate negative correlation was found between free triiodothyronine (fT3) levels and the stage of liver fibrosis (rs=–0.51; p=0.03), as well as the NYHA functional class of HF (rs=–0.45; p=0.04). Free T3 levels significantly decreased as liver fibrosis progressed (F3–F4) and HF decompensation worsened (p<0.05). Thus, low T3 syndrome in patients with MASLD and HF is not a primary thyroid pathology but rather a «euthyroid sick syndrome,» reflecting the severity of systemic inflammation. Conclusions. Low T3 syndrome is a frequent manifestation in comorbid MASLD and HF, associated with more pronounced metabolic profile disturbances and reflecting the severity of systemic inflammation. A decrease in fT3 levels may serve as a marker for advanced liver fibrosis and cardiac dysfunction in this patient cohort.
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Fadieienko et al. (2026) conducted a cross-sectional in Metabolic dysfunction-associated steatotic liver disease (MASLD) with or without comorbid heart failure (n=127). Comorbid heart failure with MASLD vs. Isolated MASLD was evaluated on Prevalence of low triiodothyronine (T3) syndrome (fT3 < 3.0 pmol/L). Comorbid heart failure in MASLD patients was associated with a 31.3% prevalence of low T3 syndrome vs 18.2% in isolated MASLD, with fT3 negatively correlating with liver fibrosis (rs=-0.51; p=0.03).
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