INS and metabolic dysfunction-associated steatohepatitis: Although the mechanisms by which hypothyroidism can promote the development of HCC are unknown, susceptibility to HCC may be increased by Nonalcoholic Steatohepatitis (NASH), which is in turn facilitated by hyperlipidemia, decreased fatty acid oxidation, insulin resistance, and lipid peroxidation, all of which are frequently observed in hypothyroidism (13).