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Quantitative endpoints, such as MRI-PDFF and histology, can capture subtle yet clinically meaningful changes, whereas ALT/AST and ultrasonography may miss early metabolic improvements

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The authors concluded that “The serum concentration of thyroid stimulation hormone is unsatisfactory as the thyrotrophs in the anterior pituitary are more sensitive to changes in the concentration of thyroxin in the circulation than other tissues, which rely more on triiodothyronine (T3).” They found a suppressed or undetectable TSH was not an indication or a reliable marker of over replacement or hyperthyroidism