The dissertation was aimed to increasing the efficiency of evaluation of cardiometabolic disorders among patients with non-alcoholic fatty liver disease (NAFLD) in combination with subclinical hypothyroidism (SH) by clarifying the peculiarities of their formation and ubstantiation of approaches to their early diagnosis and methods of correction. It was found that among patients with NAFLD with moderate risk of development of SH, high and very high cardiovascular risk (CVR) had 51,2± 4,5% and 57,0±5,3%, and among patients with high risk of SH - 17,6±3,4% and 29,0±4,9%, respectively. The leading risk factors of both manifestations were arterial hypertension (68.2±5.7%/82.4±6,4%), waist circumference (WC), (22,9±2,3%/48,4±1,7%), high density lipoprotein cholesterol (HDL cholesterol)<1.0 mmol/l (22,9±2,2%/37,2±4,3%), low density lipoprotein cholesterol (LDL cholesterol)> 3.0 mmol/l (24,6±2,1%/32,2±2,7%), glucose fasting>5.6 mmol/l (18,6±1,9%/22,9±2,5%), sedentary lifestyle (24,6±1,9%/32,2±2,7%). Changes in metabolic parameters in the form of more reliable increase of triglyceride levels (p <0.001), HDL cholesterol (p=0.023), GGTP (p <0.001), insulin (p = 0.003), C-reactive protein (p <0.05) depended from the level of thyroid-stimulating hormone (TSH), the age of patients, the degree of CVR in patients with NAFLD in combination with SH and indicated the contribution of thyroid dysfunction to the formation of cardiometabolic risk. Indicators of endothelial dysfunction (ED) in patients with NAFLD in combination with SH had a relationship with the level of TSH, manifestations of dyslipidemia, insulin resistance in the form of higher values of circulating desquamated epithelial cells (CDEC), p=0.004 and vasculothelenthelial growth factor (VEGF-A), p=0.001 in the group of patients with high as compared to moderate CVR, which confirms the association of the studied parameters with high risk of cardiovascular events in the presence of SH. In 53.4±4.8% of patients with NAFLD in combination with SH compared with isolated NAFLD (26.3±2.8%, p<0.001), there was an atherosclerotic plaque (AP) and a reliable thickening of the thickness of the intima-media complex (TIMC) depending on the level of TSH and age (p <0.001), as markers, which determine the higher rate of progression of atherosclerosis in patients with NAFLD in the presence of SH. Already, during the formation of moderate CVR, AP are present in 27.9±2.6% of NAFLD patients in combination with SH compared to patients with high risk - 54.5±4.6%, ?2=4.4, p=0.04. A significant reduction in the length of telomeres in the blood (p=0.038) and buccal epithelium (p <0.001) was observed depending on the level of TSH, it was associated with the age below 50 years (p= 0.001 and p= 0.010, respectively), with hyperinsulinemia (p = 0.016), TIMC (p = 0.016). The telomeric length of less than 0.8 increases the likelihood of a higher CVR. The presence of feedback relationships between the length of telomere in the blood and CDEC, p=0,028; TG, p=0.046; insulin, p=0,045; OS, p=0,041 and CRP, p=0,036 confirms the participation of hormonal and metabolic parameters in the processes of vascular aging. Application of multivariate model of prediction of CVR in patients with NAFLD in combination with SH due to telomere length in buccal epithelium, level of CRP and CDEC for improvement of quality and accuracy of determination of moderate CVR; the length of telomeres in the blood, LDL cholesterol, VEGF-A, and TSH-high/very high-risk will provide early diagnosis to prevent the development of adverse cardiovascular events. Integrated therapy with compulsory administration of levothyroxine, rosuvastatin, and betargin contributes to the reliable compensation of thyroid status in patients with NAFLD in combination with SH compared to patients undergoing only substitution and baseline therapy (p<0.05). Significant changes in the cardiometabolic parameters in the form of lowering the level of TG, LDL cholesterol, indicators of enzymatic activity of the liver - ALT and GGTP, and the increase in HDL cholesterol with normalization of vascular endothelial parameters of CDEC, VEGF-A, CRP and TNF-?, indicate the ability to prevent development cardiovascular diseases in the future in this category of patients. The scientific recency consist that in the work based on the system approach, scientific data on the involvement of thyroid dysfunction at the stage of the formation of SH in the pathogenetic mechanisms of the development of NAFLD and the connection of the rates of formation of cardiovascular risk with thyroid stimulating hormone levels in patients with NAFLD. For the first time, the evaluation of adverse cardiometabolic predictors of cardiometabolic risk formation in patients with NAFLD in combination with SH below the age of 50 years, which predetermined higher rates of progression of atherosclerosis carotid artery and "vascular aging", in compression with that of patients with isolated NAFLD. The multivariate model for prediction cardiometabolic risk based on new data on the predictive value: TSH, CRP, CDEC, LDLC, VEGF-A and telomeric lengths is proposed, that determines the probability of formation of moderate and high cardiometabolic risks. The expediency of the complex application of substitution therapy, cytoprotection and statin therapy in patients with NAFLD in combination with SH is scientifically substantiated to prevent the development of higher degrees of cardiometabolic risk against the background of normalization of the functional state of the liver, achievement of target lipid levels and compensation of thyroid function
