Hypothyroidism-Induced Nonalcoholic Fatty Liver Disease. Yup, It’s A Thing.

You might have noticed that I haven’t posted a new article in a few years, but I’m back. I’ve discovered a number of recently published studies related to hypothyroidism that I just have to share with you. Stay tuned over the coming months for a dozen brand new articles here at Hypothyroid Mom, and they are doozies.

Today it’s all about hypothyroidism-induced nonalcoholic fatty liver disease. Yup, it’s a thing.

I’ll never forget the day many months ago when I posted this image on the Hypothyroid Mom Facebook page. It was about the signs of hypothyroidism related to the liver including elevated liver enzymes, non-alcoholic fatty liver disease, autoimmune hepatitis, primary biliary cholangitis, and cirrhosis of the liver. The comments kept flooding in for days and I can’t stop thinking about sharing this with you in case you may be going through something similar.

I’ve literally come home from Doctors today and he told me my liver enzymes are really high and has ordered me to go for a ultrasound. I didn’t know that it could be related to my hypothyroidism.

For years especially at hospital or new GP would say I had elevated liver enzyme test results but didn’t know why or what .. I was hypothyroid for over 6 years before they removed it completely .. tests were for crest syndrome/scleroderma so never made a connection to my thyroid.

I was diagnosed with fatty liver a few years ago and no one has mentioned any connection between my hypothyroidism and the fatty liver. Ugh. I need to read more and put more effort into this and stop just accepting. Thank you Hypothyroid Mom for the info!!

Fatty liver disease. They said it’s caused because I’m overweight. No one mentioned that it could be hypothyroidism.

Had to be induced 2 weeks early due to cholestasis diagnosis during pregnancy. Liver enzymes always elevated. 

My liver enzymes are elevated and my doctor says it has nothing to do with my thyroid. I have to do an ultrasound to check my liver. Now I’m wondering. 

I was diagnosed with Hashimoto’s thyroiditis and then PBC (primary biliary cholangitis) a year later. Started with high liver enzymes. Now I have 9 autoimmune diseases.

Yes I have non-alcoholic fatty liver disease!!!!

I have PBC (primary biliary cholangitis), AIH (autoimmune hepatits), and have Cirrhosis of the liver from them. Started with hypothyroidism when I was 20. 

I have been hypothyroid for years. My tests 2 years ago came back with fatty liver disease. I have been teetotal (never drinking alcohol) for 31 years and my doctor would not believe me, just kept asking how many units a week I really drank. 

My doctor was baffled with my high liver enzymes and assumed I was a drinker. When I told her I have a glass of wine maybe once a month. She then said it was nonalcoholic fatty liver.

My Doctor told me my liver numbers look like that of someone who has drunk a lot of alcohol for many years. She didn’t believe me when I told her that I don’t drink at all and stopped when I was 24. I’m now 49. 

I have had elevated liver enzymes and Primary Biliary Cholangitis. This made me very sick and was yellow from head to toe. 

I’m hypothyroid and was undiagnosed for years. Now have fatty liver disease and cirrhosis. 

Thank you! I have no idea why my liver is failing. The answer from the doctor – lose weight. 

Thyroid and gallbladder removed 30 years ago, 4 months apart. Last fall liver enzymes were elevated. Prognosis: possible autoimmune hepatitis. Will add to ever growing list of monitored autoimmune issues.

Yip I have a fatty liver and they said I must drink too much alcohol. I had to stop her in her tracks to say I DON’T DRINK. Hate when they make assumptions.

Hypothyroidism-induced nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) represents one of the leading causes of chronic liver disease globally. Since thyroid hormones control the metabolism of lipids, one theory is that hypothyroidism causes hyperlipidemia (high LDL cholesterol and triglycerides), and that excess of fats in the blood is the key factor in the development of NAFLD.[1]

The connection to hypothyroidism is so strong that hypothyroidism-induced NAFLD was acknowledged recently as a distinct disease entity and given its very own name HIN, short for hypothyroidism-induced nonalcoholic fatty liver disease.[2] The association between hypothyroidism and NAFLD remains controversial because it is a very new theory that requires more research to understand the underlying mechanisms but the very fact that it has been given a name gives you the sense of how serious researchers have become about the hypothyroidism connection. Given the number of Hypothyroid Mom followers that are being diagnosed with NAFLD, the connection doesn’t surprise me one bit.

A systematic review and meta-analysis in 2021 discovered that the prevalence of NAFLD in people with hypothyroidism ranged from 21.67% to 66.67%.[3]

In 2024, researchers found that the prevalence of nonalcoholic fatty liver disease in patients with hypothyroidism, excluding other confounding risk factors, to be a whopping 84%.[4]

The European Association for the Study of the Liver (EASL), the European Association for the Study of Diabetes (EASD), and the European Association for the Study of Obesity (EASO) issued joint guidelines.[5] They recommend screening for liver disease in all adults with hypothyroidism and hyperthyroidism. And in all adults with NAFLD, they recommend screening for thyroid disease.

The American Association for the Study of Liver Diseases has also issued practice guidance.[6]

 Initial evaluation of patients with suspected NAFLD should carefully consider the presence of commonly associated comorbidities such as obesity, dyslipidemia, IR or diabetes, hypothyroidism, polycystic ovary syndrome, and sleep apnea.

~Naga, D., et al. Hepatology. 2018

Benefits of Thyroid Medication for NAFLD

In the International Journal of Endocrinology, research was published on the benefits of levothyroxine hormone replacement medication on nonalcoholic fatty liver disease. For patients with significant subclinical hypothyroidism, levothyroxine treatment cut the rate of nonalcoholic fatty liver disease in half after 15 months.[7]

Hashimoto’s Thyroiditis & Autoimmune Hepatitis

Do not judge a book by its cover. Time and time again I hear from hypothyroid people who are diagnosed with NAFLD and health care practitioners insist they must be drinking too much when they are not. The connection to hypothyroidism is not well known and I fear there are patients with NAFLD in which thyroid dysfunction is never considered as a possible cause.

Here’s another thing to know. Over the years, time and time again, I hear from people with the thyroid autoimmune condition Hashimoto’s thyroiditis who develop multiple autoimmune diseases over time. And do you know the autoimmune disease that I hear about often? Autoimmune hepatitis.

Researchers have been warning that autoimmune hepatitis is too often misdiagnosed as NAFLD.[8] Physicians are much more familiar with NAFLD, so considering an alternative diagnosis like autoimmune hepatitis might be missed. Early diagnosis is key to prevent further damage to the liver.

Thyroid Autoimmunity & Primary Biliary Cholangitis

In an autoimmune disease, your immune system, which is designed to protect you against foreign things like infections, mistakes a healthy body part as being not a normal part of your body and creates antibodies to attack it.

In Hashimoto’s thyroiditis, the immune system attacks the thyroid. In autoimmune hepatitis, the immune system attacks the liver. In primary biliary cholangitis, the immune system attacks the bile ducts.

Autoimmune hepatitis and primary biliary cholangitis are the two most common forms of autoimmune liver diseases. In a 2023 study published in Health Sciences Medicine, researchers discovered 34% of subjects with autoimmune liver disease were also diagnosed with autoimmune thyroiditis, primarily Hashimoto’s thyroiditis. After autoimmune thyroiditis, the most common autoimmune disease to coexist with autoimmune liver disease was Sjogren syndrome (19%). Other coexisting autoimmune diseases were inflammatory bowel diseases (7%), rheumatoid arthritis (4%), autoimmune skin disease (4%), scleroderma (3%), and systemic lupus (3%).[9]

In this same study, researchers also found the number of thyroid nodules per patient was significantly higher in the autoimmune liver disease group. Their conclusion:[9]

In autoimmune liver diseases (AILD), autoimmune thyroiditis are common. Thyroid pathologies are missed in most patients unless a careful and detailed examination is not performed. Thyroid ultrasonography should be performed in addition to laboratory investigations in the routine follow-up of patients with AILD.

~Keskin, C., et al. Health Sciences Medicine, 2023

READ NEXT: 10 REASONS TO USE INFRARED SAUNA FOR THYROID HEALTH

References:

[1] Patel, M., et al. Prevalence of Nonalcoholic Fatty Liver Disease in Hypothyroid Subjects: A Cross-sectional Comparative Study. Indian Journal of Medical Specialities. July-Sep 2023;14(3):145-151.

[2] Lonardo, A., et al. Pathogenesis of hypothyroidism-induced NAFLD: Evidence for a distinct disease entity? Dig Liver Dis. Apr 2019;51(4):462-470.

[3] Zeng, X., et al. The relationship between non-alcoholic fatty liver disease and hypothyroidism. Medicine (Baltimore). 30 Apr 2021;100(17):e25738.

[4] Dalai, S.P., et al. Study of Prevalence of Non-Alcoholic Fatty Liver Disease in Hypothyroidism and Possible Association of Hypothyroidism with NAFLD Fibrosis Score in Odisha. JK Science. Sept 2024;26(3):139-144.

[5] Hatziagelaki, E., et al. NAFLD and thyroid function: pathophysiological and therapeutic considerations. Trends in Endocrinology & Metabolism. Nov 2022;33(11):755-768.

[6] Naga, C., et al. The diagnosis and management of nonalcoholic fatty liver disease Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. Jan 2018;67(1):328-357.

[7] Liu, L., et al. Benefits of Levothyroxine Replacement Therapy on Nonalcoholic Fatty Liver Disease in Subclinical Hypothyroidism Patients. International Journal of Endocrinology. 04 April 2017;5753039.

[8] Dalekos, G.N., et al. NAFLD and autoimmune hepatitis: Do not judge a book by its cover. Eur J Intern Med. May 2020;75:1-9.

[9] Keskin, C., et al. A detailed analysis of thyroid disorders in autoimmune liver diseases. Health Sciences Medicine. 28 Sept 2023;6(5):888-892.