Treatment of Hepatic Hypothyroidism

By Dr. Scott Isaacs

Hepatic hypothyroidism is not a thyroid disorder and is not treated with thyroid medications, thyroid supplements, or a thyroid diet. Hepatic hypothyroidism can be misdiagnosed as Hashimoto’s or a T-3 conversion problem by functional medicine leading to these inappropriate treatments. Technically, hepatic hypothyroidism is called intrahepatic hypothyroidism because it defines the hormonal milieu within an injured fatty liver where thyroid hormone receptors are dysfunctional. This is a common occurrence in patients who have fatty liver disease. When an endocrinologist tells you that your thyroid tests are normal and your symptoms are not your thyroid, they are not gaslighting you. They are not ignoring your symptoms. It means that your symptoms are not from a thyroid disorder, and there is a need to look for other causes of the symptoms.

Hepatic hypothyroidism from a fatty liver can cause symptoms that can be mistaken for a thyroid disorder. Don’t let functional medicine gaslight you with unnecessary thyroid supplements, thyroid diets or extra T3. If your thyroid tests are normal and you have symptoms like fatigue, ask your doctor if you could have a fatty liver. The best way to treat hepatic hypothyroidism is to focus on established treatments for fatty liver disease.

The management of fatty liver disease starts with weight loss to reduce liver fat. Weight loss with a diet plan is the first step. Fast weight loss under medical supervision has been proven to work best because it is more motivating, compared to slow weight loss that can be frustrating. There are no medications FDA-approved to treat hepatic hypothyroidism. Resmetirom is completing phase III trials 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. Resmetirom works to overcome some of the effects of intrahepatic hypothyroidism by stimulating a thyroid hormone receptor located in the liver. Treating fatty liver disease with weight loss addresses the root cause of hepatic hypothyroidism by helping to heal a hypothyroid liver.

Medications used to treat fatty liver disease include diabetes medications (such as GLP-1 medications tirzepatide - Mounjaro, semaglutide - Ozempic, Wegovy, Rybelsus or liraglutide-Saxenda, Victoza) and weight loss medications such as Qsymia or Contrave. Even better results can be obtained by using a combination of medications. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a fatty liver expert and offers accurate diagnosis and state-of-the-art treatment of thyroid disorders. To learn more, contact the office in Atlanta, Georgia.