Aim: This study aims to investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with subclinical and overt hypothyroidism at a tertiary care center in Northern India. Additionally, it seeks to establish the correlation between NAFLD and hypothyroidism, focusing on the different grades of fatty liver and the degree of hepatic stiffness. Methods: A cross-sectional study conducted on patients presenting with hypothyroidism. The sample included individuals diagnosed with subclinical or overt hypothyroidism. NAFLD was assessed using ultrasonography, and hepatic stiffness was measured using transient elastography. Patients were categorized based on the severity of NAFLD and the extent of liver stiffness. Statistical analyses were performed to determine the correlation between hypothyroidism severity, fatty liver grades, and hepatic stiffness. Results: The study found a high prevalence of NAFLD among patients with hypothyroidism. The prevalence was significantly higher in patients with overt hypothyroidism compared to those with subclinical hypothyroidism. There was a positive correlation between the severity of hypothyroidism and the grades of fatty liver. Increased hepatic stiffness was observed in patients with higher levels of TSH, indicating a progression toward more severe liver conditions. Serum free thyroxine (FT4) levels were inversely related to the prevalence and severity of NAFLD. Discussion: The findings suggest that hypothyroidism, particularly in its overt form, is a significant risk factor for NAFLD. The correlation between decreased FT4 levels and increased NAFLD prevalence underscores the importance of thyroid function in lipid metabolism and liver health. These results highlight the need for routine screening for NAFLD in patients with hypothyroidism and suggest that managing thyroid dysfunction could be crucial in preventing and treating NAFLD. Further research is needed to elucidate the underlying mechanisms linking these conditions and to develop targeted therapeutic strategies.

Introduction: AA amyloidosis, a protein misfolding disorder characterized by kidney impairment, remains underinvestigated in the Indian context. This study aimed to comprehensively analyze the clinicopathological characteristics and underlying causes of biopsy-proven renal AA amyloidosis in an Indian patient population. Methods: In this retrospective cross-sectional study, 18 patients diagnosed with AA amyloidosis between March 2022 and May 2024 were meticulously evaluated. Clinical data, laboratory investigations, and renal biopsy findings were collected and analyzed. Results: The study population predominantly comprised males (83.3%) with a wide age range (17-65 years). Chronic infectious diseases were the primary cause (77.8%), including tuberculosis 78.6% (both treated and ongoing) and hepatitis infections 21.4%. Autoimmune conditions like Rheumatoid Arthritis and Ankylosing Spondylitis were identified in a smaller proportion (16.7%). Proteinuria, indicative of glomerular dysfunction, was universally observed. Significant hypoalbuminemia was prevalent, with a substantial portion exhibiting severe deficiency (66.6%). The presence of RBCs and RBC casts highlighted glomerular involvement and potential complications in 38.9% of patients. Elevated creatinine levels pointed towards potential kidney dysfunction in a third of the patients. Biopsy analysis confirmed the presence of amyloid deposits with positive markers for serum amyloid A protein. Conclusions: This study sheds light on the diverse clinical and pathological presentations of AA amyloidosis in a well-defined Indian patient cohort. The findings emphasize the predominance of infectious etiologies and the importance of considering age, gender, and underlying chronic conditions for a comprehensive understanding of AA amyloidosis in the Indian population.