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Abstract
Abstract. The article presents the results of a prospective controlled clinical study aimed at evaluating the effectiveness of hepatoprotective therapy using ademethionine as part of a comprehensive treatment approach for patients with hypothyroidism and metabolic dysfunction-associated steatotic liver disease (MASLD). The study included 90 participants divided into three groups: the main group received combined therapy with levothyroxine and sublingual ademethionine; the comparison group received only thyroid hormone replacement therapy; and the control group consisted of apparently healthy individuals. All patients underwent a comprehensive clinical and laboratory examination before and after a 12-week course of treatment, including assessment of liver function parameters, thyroid status, insulin resistance index, and liver orphometric and structural characteristics based on ultrasound data. As a result of the combined treatment with levothyroxine and ademethionine in the main group, a statistically significant reduction was observed in the activity of liver enzymes – alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), sorbitol dehydrogenase (SDH), and lactate dehydrogenase (LDH); improvement in thyroid profile (reduction in thyroidstimulating hormone (TSH), increase in free thyroxine (FT4)); reduction in insulin resistance (decreased homeostatic model assessment of insulin resistance (HOMA-IR) index); improvement in ultrasound liver parameters (reduction in steatosis grade); as well as decreased body mass index and waist circumference (WC). In the comparison group, similar changes were less pronounced and mostly statistically insignificant. In the control group, all parameters remained stable. The obtained results confirm the clinical rationale for including ademethionine in treatment regimens for patients with hypothyroidism and MASLD to achieve more effective correction of hepatic and metabolic disorders, prevention of steatohepatitis progression, and reduction of the risk of fibrotic changes in hepatic parenchyma. The use of a comprehensive approach makes it possible to influence both the etiopathogenetic mechanisms and clinical manifestations of comorbid pathology, thereby increasing treatment efficacy and opening perspectives for further research in this field
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