These results were disputed in subsequent evaluations based on the degree of hypothyroidism and might be inconsistent due to the small number of studies included; instead of thyroid hormones, THS might play a key role in the onset and progression of NAFLD.17 In Zeng et al. meta-analysis, performed in 2021, also higher TSH levels have been observed in NAFLD patients; however, the conventional abdominal ultrasound was used as the diagnostic method for NAFLD in 9 of the 10 studies and liver biopsy in one of them [13]. This evidence concerns the gene TG and metabolic dysfunction-associated steatotic liver disease.