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In hypothyroid states, insulin receptor substrate (IRS)-mediated PI3K(phosphatidylinositol 3-kinase)/Akt(protein kinase B) signaling is attenuated, reducing insulin sensitivity and increasing hepatic glucose output ( In parallel, hypothyroidism disrupts systemic lipid metabolism by suppressing lipoprotein lipase (LPL) activity, impairing cholesterol efflux, and reducing triglyceride clearance ( 2.2.2 Steatohepatitis (MASH): oxidative stress, inflammation, and immune activation The progression from simple steatosis to steatohepatitis is critically mediated by oxidative stress and inflammation

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