Hepatic Hypothyroidism

Many people struggle with weight gain, fatigue, symptoms of a thyroid disorder or Hashimoto’s thyroiditis but are told thyroid function is normal. At Atlanta Endocrine AssociatesDr. Scott Isaacs is a hepatic hypothyroidism expert and offers accurate diagnosis and state-of-the-art weight management. To learn more, contact the office in Atlanta, Georgia or request an appointment online.

For many people the issue is not the thyroid, it’s hepatic hypothyroidism also known as intrahepatic hypothyroidism caused by an injured fatty liver or NAFLD. The liver is one of the main sites of action for thyroid hormones, so if you have a hypothyroid liver, it does not properly respond to normal levels of thyroid hormones. NAFLD is very common and underdiagnosed. Recent studies have shown that 38% of middle-aged adults have a fatty liver and the symptoms of a fatty liver can be similar to the symptoms of hypothyroidism. The most common symptom of a fatty liver is fatigue.

Hepatic hypothyroidism is not a thyroid disorder but can be misdiagnosed as Hashimoto’s by functional medicine. Avoid unnecessary thyroid supplements, thyroid diets or extra T3 and focus on established treatments for NAFLD.

If you have a hypothyroid liver, thyroid hormones aren't processed properly. The liver plays a major role in activating thyroid hormone, converting the inactive form T4 into the active form T3. But if the liver is hypothyroid and filled with fat, it can’t convert thyroid hormone properly and creates more of an inactive thyroid hormone, reverse T3.

If you have hepatic hypothyroidism you want your thyroid hormones to work properly by focusing on liver health. To cure a fatty liver, start by reducing calorie intake. Focus on a Mediterranean style diet with whole grains, lean protein and lots of fresh vegetables and some fruit. These are foods that make you feel full, so you body craves fewer calories. Another tip: drink at least 2 cups of coffee daily, which has been shown to improve a fatty liver. You don’t need to take a thyroid supplement and can get the right amount of iodine with a couple of pinches of iodized salt or a standard multivitamin.

Foods to avoid include sugar, high fructose corn syrup, processed carbohydrates, starchy foods and saturated fat. These foods cause liver inflammation and hepatic insulin resistance in addition to the creation of new liver fat known as de novo lipogenesis. Fat starts to build up inside the liver which becomes inflamed. This is known as nonalcoholic steatohepatitis, NASH. The healing process leaves scar tissue known as fibrosis which leads to cirrhosis and liver cancer.

Gluten-free diets have been hyped on the internet but only helpful in about one in seven people. The issue for most is not the gluten, but the carbohydrates. Avoid gluten-free processed junk food like cookies, bread, and pizza. Processed gluten free products contain a lot of sugar and bad carbs not to mention high amounts of arsenic. Another internet myth is avoiding broccoli, cabbage and other cruciferous vegetables, which may be eaten and are encouraged for liver health.

The management of hepatic hypothyroidism starts with getting fat out of the liver. Weight loss with a diet plan or fast weight loss program is vital. Although there are no approved medications for fatty liver disease, diabetes medications (such as tirzepatide - Mounjaro or semaglutide - Ozempic) and Weight loss medications are an option.

At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and offers noninvasive diagnosis and state-of-the-art treatment. To learn more, contact the office in Atlanta, Georgia or request an appointment online.

Scott Isaacs, MD Endocrinologist and Weight Loss Specialist

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