Hepatic Hypothyroidism

Atlanta Endocrine Associates

Scott D. Isaacs, MD

Endocrinologist & Weight Loss Specialist located in Atlanta, GA

When you have hepatic hypothyroidism, officially known as "intrahepatic hypothyroidism" you may struggle with obesity, fatigue, or vague abdominal pain but thyroid tests are normal and thyroid medications or functional medicine treatments do not help. The symptoms of a hypothyroid liver are not from "hypothyroidism" but can be misdiagnosed as a thyroid disorder and mistreated with gluten-free diets, thyroid supplements or excessive amounts of T3 medications. The root cause of intrahepatic hypothyroidism is liver cell injury from a fatty liver resulting in resistance to otherwise normal thyroid hormones. Located in Atlanta, Dr. Scott Isaacs offers accurate diagnosis and state-of-the-art treatment of hepatic hypothyroidism focusing on liver health instead of bogus thyroid treatments. To get started, call the office, or book an appointment online today.

Hepatic hypothyroidism also known as "intrahepatic hypothyroidism" is when an injured fatty liver is resistant to otherwise normal thyroid hormones.

What is hepatic hypothyroidism?

Hepatic hypothyroidism is caused by disrupted thyroid hormone action inside an injured fatty liver

Hepatic hypothyroidism is not a thyroid disorder. Hepatic hypothyroidism is a state that occurs within a fatty liver where the liver is essentially hypothyroid due to decrease responsiveness of thyroid hormone receptors (thyroid hormone resistance) and altered expression of deiodinases, leading to decreased (active) T3 production increased reverse (inactive) T3 production within the liver. This is referred to as an intrahepatic hypothyroid hormonal milieu.

In simple terms, 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 otherwise normal thyroid hormones. 

What are the symptoms of hepatic hypothyroidism?

The symptoms of hepatic hypothyroidism are the same as the symptoms of fatty liver disease and can be mistaken for a thyroid disorder. Symptoms might include:

  • Weight gain
  • Obesity
  • Increased abdominal fat
  • Fatigue
  • Sluggishness
  • Vague abdominal pain on the right side

How is hepatic hypothyroidism diagnosed?

Although there are no official diagnostic criteria, hepatic hypothyroidism is suspected in patients with fatty liver disease. Indicators of a fatty liver may include elevated liver enzymes (AST - aspartate aminotransferase, ALT - alanine aminotransferase) although liver tests may be normal. Hepatic steatosis (liver fat) can be seen in imaging with ultrasound, CT, or MRI of the abdomen. New noninvasive tools such as the ELF test can detect fibrosis and assess risk for progression to advanced fatty liver disease.

How does hepatic hypothyroidism affect thyroid hormone conversion?

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 storage hormone T4 into the active form T3 by deiodinase enzymes. Normally deiodinase-1 converts T4 to active T3, but if the liver is fatty, deiodinase-3 takes over increasing conversion of T4 to inactive reverse T3. The decrease in the T3 to reverse T3 ratio (T3/rT3) results in a downregulation of the hepatic thyroid hormone pathway.

How is hepatic hypothyroidism treated?

When you have a hepatic hypothyroidism, adjusting thyroid medications, trying different brands or taking extra T3 does not work. Gluten-free or special thyroid diets do not help. Thyroid supplements do not work and are totally unnecessary.  At Atlanta Endocrine Associates we specialize in the management of hepatic hypothyroidism as a liver disease focusing on treatments to help heal a hypothyroid liver. Treatment consists of optimizing thyroid hormone replacement in patients who have diagnosed thyroid disease while simultaneously using evidence-based treatments for fatty liver disease. 

Although there are no medications that have been officially approved to treat hepatic hypothyroidism, Resmetirom is entering the final states of testing as a treatment for more advanced forms of fatty liver disease. Resmetirom is a liver-directed, oral, thyroid hormone receptor-β agonist designed to improve liver health by increasing hepatic fat metabolism and reducing lipotoxicity. Essentially, the drug works to try to overcome some of the effects of intrahepatic hypothyroidism by stimulating a thyroid hormone receptor located in the liver. 

Treatments for nonalcoholic fatty liver disease starting with weight loss address the root cause of hepatic hypothyroidism by helping heal a hypothyroid liver. Lifestyle is always first line treatment. Medications used to treat fatty liver disease include diabetes medications (such as GLP-1 medications tirzepatide - Mounjarosemaglutide - OzempicWegovy, Rybelsus or liraglutide-Saxenda, Victoza). Weight loss medications such as Qsymia or Contrave or any weight loss treatment can help reduce liver fat. 

At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and an expert in thyroid disorders. He strives to avoid the misdiagnosis of a thyroid disorder that can be inproperly treated with unnecessary medications and expensive supplements. To learn more, contact the office in Atlanta, Georgia or request an appointment online.