Follow these ten steps to manage hepatic hypothyroidism and heal a hypothyroid liver.
Step 1: Detox and cleanse the liver
Beware of bogus liver detox and cleanse supplements. From a medical perspective, there is no accepted way to cleanse or detox the liver. Liver cleanses and detoxes sold on the internet as frauds or snake oil and nothing shows that these products work. In fact, some liver detox supplements may harm the liver. Green tea and turmeric can cause liver damage from hepatitis and coffee enemas can lead to infections or severe electrolyte deficiencies. The best way to cleanse or detox your liver is to eat healthy unprocessed foods like vegetables, fruits, and whole grains. To further reduce toxins in the liver, go organic as much as possible. Drink 2 liters of filtered water or lemon water every day to stay hydrated and help flush endocrine-disrupting environmental toxins stored in fat that are released with weight loss.
Step 2: Cut the calories
To heal a fatty liver, start by reducing calorie intake. Focus on lowering daily calories. I recommend foods that make you feel full, so your body craves fewer calories (vegetables, fruits, whole grains, nuts, seeds, seafood, lean poultry, low-fat dairy, and plant-based proteins). The exact combination of macros is not as important as the calories, so you can customize your ratio of carbohydrates, proteins, and fats to what works for you.
Step 3: Avoid foods that are bad for the liver
Avoid sugar, high fructose corn syrup, processed carbohydrates, starchy foods, and saturated fat (red meat, fatty meat, butter, cheese, coconut oil). These foods cause inflammation and insulin resistance in the liver. Fructose is the most toxic of the sugars inducing hepatic insulin resistance. Extra sugar and saturated fat lead to the creation of new liver fat known as de novo lipogenesis or DNL.
Step 4: Avoid gluten-free junk food
Avoid gluten free processed food. Gluten-free diets have been publicized as a cure for thyroid disease but do not work for most people. The issue is not gluten, it is the unhealthy carbohydrates that are usually in foods with gluten. It’s OK to go gluten-free but avoid gluten-free processed junk food like pasta, bread, and pizza. Processed gluten-free foods contain more sugar and worse carbs, not to mention excessive amounts of arsenic and other heavy metals.
Step 5: Drink coffee
Coffee used to be a vice, now it is a virtue. I recommend that you drink at least 2 cups of coffee daily, which has been shown to improve liver health. The liver benefits of coffee come from brewed black coffee, not fancy espresso drinks. High calorie add-ins like cream and sugar will negate the beneficial effects of coffee, so keep it simple (regular black coffee is best). Don’t overdose on caffeine or drink it too late in the day when it could affect your sleep.
Step 6: Minimize alcohol
You don’t have to totally avoid alcohol but drinking too much or binge drinking can make a fatty liver much worse. Experts recommend no more than one drink a day for women and two for men.
Step 7: Get the right amount of iodine
Too much or too little iodine can be detrimental to thyroid function. Recommended Dietary Allowance (RDA) for adult men and women is 150 μg/day. Most people get this much in their daily diet. If you use salt, use iodized salt. Just a few pinches a day is enough, and the sodium will be minimal compared to eating processed foods and restaurant foods that contain massive amounts of hidden sodium. There is no need to take thyroid supplements which can be harmful and overload the thyroid with too much iodine. Do not take supplements that contain sea vegetables like kelp, bugleweed, or bladderwrack. Other red flag ingredients in thyroid supplements include animal glandular extracts that use Latin words to describe the type of animal like porcine (pig) or bovine (cow). Many supplements contain tyrosine, an amino acid that is the backbone of thyroid hormones. However, tyrosine is part of any protein and taking a pill with extra does nothing more.
Step 8: Watch the iron
Hepatic hypothyroidism makes people especially vulnerable to deposition of iron in the liver, known as hemochromatosis. People with NAFLD and NASH commonly have elevated ferritin levels. Higher ferritin (iron) is linked to more severe liver disease. You should avoid vitamins and supplements that contain iron unless prescribed by your doctor. High ferritin levels are associated with inflammation, especially in people who have other obesity-related chronic inflammatory conditions such as diabetes and metabolic syndrome.
Step 9: Eat Foods High in Vitamin E
Vitamin E remains a controversial treatment for NAFLD and NASH. Vitamin E 800 IU daily was beneficial in patients who had NASH proven by biopsy and did not have diabetes. However, the effects are short lived and there can be substantial risks such as increased risk for bleeding, cancer, and death. I rarely recommend vitamin E supplements but do advise that you get vitamin E through food (nuts, seeds, greens, squash, mango, avocado).
Step 10: See your doctor
The management of hepatic hypothyroidism starts with getting fat out of the liver. Weight loss with a diet plan is helpful for patients that need to lose a lot of weight and have had difficulty doing it alone. 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. 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. 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 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.
