Hypothyroid and liver enzymes

The Connection Between Hypothyroidism and Non-alcoholic Fatty Liver Disease

In a cross-sectional study, Korean researchers investigated the connection between the broad spectrum of hypothyroidism and non-alcoholic fatty liver disease (NAFLD). Their findings were published online in “Non-alcoholic fatty liver disease across the spectrum of hypothyroidism,”1 which appeared in the Journal of Hepatology.

A total of 4,648 patients were included in the study; the researchers evaluated health check-ups from these patients. The mean age of the participants was 48.6±11.8 years old, and 62.4% were female.

Researchers divided the patients into two groups—a case group and a control group. There were 2,324 participants with hypothyroidism in the case group; and there were 2,324 participants in the control group. Patients in the control groups were age- and sex-matched to the participants in the case group.

Study participants were classified as having either subclinical thyroid-stimulating hormone (TSH) levels of greater than or equal to 4.1 mIU/L and normal free thyroxine (T4) levels between 0.7 and 1.8 ng/dL, or they were categorized as having overt hypothyroidism, with a free T4 of less than 0.7 ng/dL.

NAFLD was diagnosed in these patients by using typical ultrasonography. Another diagnostic criterion for NAFLD is alcohol consumption of less than 20 g/day and an absence of other causes of liver disease.

Researchers found that NAFLD was significantly linked to hypothyroidism (30.2% patients in the case group vs 19.5% patients in the control group; p<0.001).

Additionally, the prevalence of NAFLD and abnormal liver enzyme levels (ALT, which is defined as greater than 33/25 IU/L) progressively increased as the grade of hypothyroidism increased. For patients who had subclinical hypothyroidism, 29.9% of them had NAFLD, and for patients who had overt hypothyroidism, 36.3% of them had NAFLD (p<0.001). Also, researchers found that 20.1% of patients with subclinical hypothyroidism and 25.9% of patient with overt hypothyroidism had abnormal ALT (p<0.001).

Researchers also used multivariate regression analysis. This analysis showed that NAFLD was statistically significantly linked to hypothyroidism (odds ratio : 1.38; 95% confidence interval : 1.17 to 1.62). The analysis also showed that NAFLD was statistically significantly linked to the grade of hypothyroidism in a dose-dependent manner (OR: 1.36; 95% CI: 1.16 to 1.61 for patients with subclinical hypothyroidism and OR: 1.71; 95% CI: 1.10 to 2.66 for patients with overt hypothyroidism).

The research team determined that subclinical hypothyroidism—even in the range of upper normal TSH levels—was linked to non-alcoholic fatty liver disease in a dose-dependent manner. Furthermore, hypothyroidism is closely linked to NAFLD separate from known metabolic risk factors. These findings confirm a pertinent clinical relationship between hypothyroidism and NAFLD.

Reviewed by EndocrineWeb Editorial Board View Sources Updated on: 12/16/19 Continue Reading: Ethical Considerations for Continued Observation of Thyroid Lesions

Hashimoto’s and fatty liver — the culprit is not dietary fat

By Josh Redd, DC on May 24, 2017

If you have Hashimoto’s hypothyroidism and struggle with excess weight or high blood sugar, your blood tests show may also show fatty liver (high liver enzymes). Although fatty liver has no overt symptoms, a liver filled with fat hinders detoxification, promotes inflammation, may increase gallstones and increases heart attack risk. So a fatty liver means eat less fat, right? Wrong, the culprit in fatty liver isn’t too much fat but rather too many sugars and carbohydrates.

Too many carbs are the main culprits behind the excess belly fat that is a sure sign of fatty liver. This is because sugar signals the liver to produce more fat.

This process is heightened when the liver must process fructose particularly high-fructose corn syrup found in soft drinks and other junk foods.

If you are not managing your autoimmune Hashimoto’s hypothyroidism this also may contribute to fatty liver disease. Research suggests a strong link between hypothyroidism and fatty liver disease as proper thyroid function is so vital to fat metabolism and blood sugar regulation.

From fatty liver to fatty liver disease when you have Hashimoto’s hypothyroidism

While some fat in the liver is normal, if it exceeds 5 to 10 percent of total weight of the organ, it is considered fatty liver and the first stage of non-alcoholic fatty liver disease (NAFLD). If fatty liver progresses unchecked, it can lead all the way to cirrhosis.

(Alcohol abuse can also cause fatty liver disease and the majority of alcoholics have a fatty liver.)

NAFLD is the most common liver disorder in the west, affecting as many as one third of Americans. It primarily afflicts those who overweight and middle-aged, but NAFLD is increasingly affecting children and teens due to their over consumption of sodas, sweets, and high-carb foods. High cholesterol and diabetes are typically found with NAFLD too.

People with Hashimoto’s hypothyroidism are also at a higher risk of NAFLD because of the affect of hypothyroidism on fat metabolism and liver function. This is why it’s so important to go beyond taking thyroid meds and to manage the autoimmune disease causing low thyroid function.

How to reverse fatty liver and regain liver health when you have Hashimoto’s hypothyroidism

The good news is you can reverse fatty liver before it’s too late. Even though the liver may not initially complain with symptoms, it’s important to take liver health seriously to prevent serious long-term complications. Steps to reverse fatty liver include:

Manage your autoimmune Hashimoto’s hypothyroidism with functional medicine. A big part of the battle is to manage your autoimmune low thyroid condition. Meds alone may not be enough to resolve the mechanisms and symptoms that promote fatty liver in instances of Hashimoto’s hypothyroidism. For more advice on using functional medicine to manage Hashimoto’s, contact my office. As well, follow the recommendations below.

Adopt a lower-carb, sugar-free diet. High blood sugar leads to fatty liver. To start reversing it you need to bring blood sugar down to healthy levels with a whole foods diet abundant in fibrous vegetables, healthy fats, and proteins while low in foods that spike blood sugar. Most people will begin to lose excess fat on this way of eating as well, further unburdening the liver.

Exercise daily. Exercise helps lower high blood sugar, detoxify the body, and shed excess fat, all of which will help reverse fatty liver.

Avoid alcohol and unnecessary medications. Alcohol is very hard on the liver, as are many medications. Avoid both as much as possible while working to reverse fatty liver.

Lower inflammation. The liver actually plays an important role in inflammation and lowering overall inflammation will likewise ease its burdens. The most important ways to do this are by removing foods from your diet that promote inflammation (gluten and dairy are the most common) and minimizing exposure to toxins and chemicals.

Take natural anti-inflammatory compounds. Certain nutritional compounds really shine when it comes to lowering inflammation. These include high doses of emulsified turmeric and resveratrol, absorbable forms of glutathione, vitamin D, and many other compounds. Ask my office for more advice.

Support liver detoxification pathways. If your liver cells are clogged with fat it may have trouble with everday detoxification duties. The liver responds wonderfully to herbs and compounds that support detoxification, such as milk thistle or n-acetyl-cysteine.

Ask my office for more ways to reverse fatty liver, support liver health, and manage your autoimmune Hashimoto’s hypothyroidism.

How to learn if you have Hashimoto’s low thyroid

Many patients are not diagnosed with hypothyroidism or Hashimoto’s until after several years and going through several doctors. It is a demoralizing journey richly illustrated in my book The Truth About Low Thyroid: Stories of Hope and Healing for Those Suffering With Hashimoto’s Low Thyroid Disease, through real-life stories from patients in my practice. Managing Hashimoto’s goes far beyond using thyroid medication as you must work to stop the immune system from attacking the thyroid. For more information on identifying and managing Hashimoto’s low thyroid, contact my office.

About Dr. Josh Redd, Chiropractic Physician — Utah, Arizona, New Mexico functional medicine

Dr. Joshua J. Redd, DC, MS, DABFM, DAAIM, author of The Truth About Low Thyroid: Stories of Hope and Healing for Those Suffering With Hashimoto’s Low Thyroid Disease, is a chiropractic physician and the founder of RedRiver Health and Wellness Center with practices in Utah, Arizona, and New Mexico. He sees patients from around the world who suffer from challenging thyroid disorders, Hashimoto’s disease, and other autoimmune conditions. In addition to his chiropractic degree, Dr. Redd has a BS in Health and Wellness, a BS in Anatomy, and a MS in Human Nutrition and Functional Medicine. He speaks across the nation, teaching physicians about functional blood chemistry, low thyroid, Hashimoto’s, and autoimmunity. You can join his Facebook page here.

The ZRT Laboratory Blog

As a follow up to our webinar with Thyroid Pharmacist Izabella Wentz, PharmD, she addresses questions about thyroid function and Hashimoto’s Disease. Here are your questions answered.

I have a patient who has your book. She has multiple gut issues, and I’ve tried to get her to eliminate wheat, gluten and dairy for years. She refuses. She wants to take antabine or the naltrexone you recommend but not change her diet. I haven’t read your book yet, but I told her she was missing the entire title, which is root cause. Please comment.

Oh no! The book is all about lifestyle and talks about the antabine & LDN being adjuncts. We both know she will likely feel much better once she gets off the gluten and dairy, unfortunately, often times people have very complicated relationships with food… some people live to eat, and it’s going to be a real challenge to get them to see food in a different way. Of course we also know about casomorphins and gluteomorphins that make dairy and gluten so addictive.

I would work with her to discover why she is so resistant to change. If she is just collecting information and trying to prepare, you may be able to point her to some great resources. It took me over a year to go gluten and dairy free as most of my meals consisted of both gluten and dairy.

She may not be ready to change at this time, the fact that she is seeing you however, is a great step for her. Some things that may encourage her to change: let her know LDN and antabine work best with an anti-inflammatory diet, have her try the diet for just 3 weeks to see how she feels off the foods, and do lgG food sensitivity testing (that was the kicker for me).

Is a thermagram a good indicator of hypo or hyper thyroidism?

I don’t have much experience with thermography, in my opinion, while the thermograms would be a helpful adjunct in diagnosing thyroid disease, inflammation, nodules and hyperactivity of the gland, I’m not sure that the information could be quantified for practical purposes such as dosing medications, etc.

Is it important or useful to do an iodine load, testing before and after the load?

I prefer the urine spot test for people with Hashimoto’s instead of the iodine loading test. Iodine is a narrow therapeutic index nutrient and can exacerbate the autoimmune attack on the thyroid, making people feel pretty terrible and accelerate the rate of thyroid tissue destruction.

Please comment further on the use of alkaline phosphatase as indicator of zinc status – I have not heard of this before.

Low alkaline phosphatase levels are usually associated with malnutrition (nutrient deficiencies), and are commonly found with hypothyroidism and Hashimoto’s. One nutrient deficiency in particular, zinc, has been negatively correlated with Alk Phos levels. Lower zinc means lower alk phos.

What causes excess oiliness on the scalp?

It could be a variety of reasons, the two main ones being androgen excess and a rebound effect from the harsh chemicals in shampoos.

What do you think about measuring Total T4 and Total T3?

Those levels may be helpful in determining the rate of binding. The free levels in the hormone are more helpful.

What did you do to decrease your androgen levels?

My two best lifestyle strategies for reducing androgen levels are 1) increasing fiber intake, which helps to prevent recirculating of hormones and eliminates excess androgens and 2) balancing the blood sugar with eating lots of good fats, proteins and limiting carbs. Of course looking at a list of supplements to be sure patients are not taking DHEA is also a helpful first step.

Do you like Armour thyroid more than Naturoid?

I prefer Nature-Throid as it has fewer fillers and the company has tighter quality controls. People with Hashimoto’s often have multiple sensitivities and are less likely to react to Nature-Throid.

Do you think desiccated thyroid (Naturethroid, Armour) is problematic for autoimmunity? Seems to be no real data supporting this long-held attitude.

I agree, it’s all anecdotal information. I have seen it in some people, but not in most. I think the NDT may contain small amounts of thyroglobulin or TPO that can upregulate the autoimmune attack. I recommend testing antibodies before and after starting NDT and looking at any changes.

Have you used Spectracell nutritional testing to find nutritional deficiencies?

Yes, I have found the Spectracell nutritional testing to be very helpful. You can find the list of all the tests I recommend at www.thyroidpharmacist.com/labs.

What is your take on reverse T3 with Hashimoto’s / Hypothyroidism?

Most people with Hashimoto’s are going ot have a co-occuring adrenal issue and nutrient deficiency, which will prevent the conversion of T4 to T3, and promote the conversion to RT3. I don’t really feel the need for testing RT3 for people with Hashimoto’s, but it may be helpful for people with non-autoimmune hypothyroid symptoms.

Could you comment on whether iodine loading is needed when testing for iodine deficiency? Do you think spot urine testing is an accurate collection of iodine stores?

I prefer the urine spot test for people with Hashimoto’s instead of the iodine-loading test. Iodine is a narrow therapeutic index nutrient and can exacerbate the autoimmune attack on the thyroid, making people feel terrible and accelerate the risk of thyroid tissue destruction.

I am a doctor who does hormone treatments. Have you found that using SR T4/T3 once a day in patients with Hashimoto’s is not as good as IR T4/T3 twice a day due to malabsorption?

I have! The fillers used to make SR T4/T3 are often malabsorbed by people with Hashimoto’s due to gut issues.

Thank you all for your great questions. You can find out more information about Hashimoto’s in Izabella’s book. She provides a free nutrient depletions chapter on her website, as well as a list of recommended labs.

Related Resources

  • Blog: Determining the Functional Causes of Hypothyroid Symptoms
  • Blog: Clearing Up the Confusion About Reverse T3
  • Web: Thyroid Imbalance

Many of my readers have reported some of the following symptoms: brittle or white-spotted nails, a tendency to get sick easily, allergies, frequent respiratory infections, an impaired sense of taste and smell, diarrhea, hair loss, impotence, loss of appetite, skin issues, depression, and impaired vision. Are you one of them? Figuring out the root causes of your Hashimoto’s-related symptoms can be challenging and overwhelming. After all, many symptoms overlap with several other conditions. But, the origin of these symptoms doesn’t have to be a mystery. Often, these symptoms stem from a deficiency in an essential trace element: zinc.

One in four individuals in the general population may be zinc deficient, including most people with hypothyroidism and Hashimoto’s. Furthermore, an estimated 17 percent of the worldwide population is at risk of inadequate zinc intake.

Zinc is involved as a catalyst in many different pathways in the body. It’s also very important for gut health, immune function, tissue healing, the conversion of T4 to T3, and the production of TSH. It can help tighten the intestinal junctions of those with intestinal permeability as well. For this reason, increasing your zinc levels may help reduce your symptoms and even lead you towards remission!

In the following article, you’ll discover:

  • What are the symptoms and causes of zinc deficiency?
  • How do low zinc levels affect Hashimoto’s?
  • Can addressing zinc deficiency help social anxiety?
  • Strategies to optimize your zinc intake

What is Zinc?

Zinc is considered an essential trace element, which means that small amounts are important to our well-being. After all, it acts as a catalyst in about a hundred different enzyme reactions required by our body, and is involved in DNA synthesis, immune function, protein synthesis, and cell division. Adequate levels of zinc are required for proper sense of taste and smell, detoxification, and wound healing.

Zinc also plays a specific role in gut health. In fact, zinc deficiency has been associated with increased intestinal permeability and susceptibility to infections, which are common triggers of Hashimoto’s, as well as reduced detoxification of bacterial toxins. Replenishing zinc has been shown to help to tighten the intestinal walls and repair intestinal permeability in other conditions such as Crohn’s disease.

In addition, zinc helps to prevent oxidative stress, which could otherwise knock your body’s antioxidant levels out of balance and damage your DNA.

Zinc and Hashimoto’s

Zinc is also an essential element for thyroid function.

A depletion in zinc prevents the conversion of the T4 hormone into the active T3 version. This could lead to symptoms like hair loss, fatigue, and weight gain, even while taking thyroid medications like Synthroid. You can read more about the effects of insufficient T3 levels here.

Zinc is also needed to form TSH, which is why those with hypothyroidism and who are constantly producing TSH are more likely to develop deficiencies in this important mineral.

When taken with selenium, (another nutrient that has been proven to be beneficial for those with Hashimoto’s), zinc has been shown to improve thyroid function.

In 2015, a study was conducted with 68 overweight or obese female hypothyroid patients who received either a zinc supplement, a selenium supplement, placebo pills, or both zinc and selenium supplements taken together. Three months later, it was noted that those taking both zinc and selenium, as well as those just taking zinc supplements, saw a significant increase in their free T3 levels. Those taking both zinc and selenium experienced a significant decrease in their TSH and an increase in T4 levels. The study concluded that zinc, when taken alone as well as in combination with selenium, can have a positive effect on thyroid function in overweight or obese patients with hypothyroidism.

The benefits of zinc supplementation in thyroid patients were also confirmed when I surveyed over 2000 of my readers and asked them what interventions worked for them. Fifty-two percent of them said taking a daily dose of 30mg of zinc made them feel better. Furthermore, 58 percent said they saw an improvement in energy, 48 percent in their mood, 30 percent in their lab results, and 25 percent in skin changes.

Symptoms of Zinc Deficiency

Symptoms of zinc deficiency can include poor wound healing, impaired taste and smell, and thin, brittle, peeling, or white-spotted nails. Those low in zinc may also have a weakened immune system and suffer from allergies or frequent colds and respiratory infections. Furthermore, depleted zinc levels can result in diarrhea, hair loss, impotence, loss of appetite, skin issues (acne, rashes, canker sores, foot fungus), depression, impaired vision, low sperm count, ADHD, unexplained weight loss, a lack of alertness, and open sores on the skin.

As I mentioned earlier, one in four individuals in the general population may be zinc deficient, and your chances increase if you have hypothyroidism or Hashimoto’s. Interestingly, in 2013, a study involving rats with induced hypothyroidism found that hypothyroidism led to changes in their serum zinc levels, suggesting that hypothyroidism also contributes to lower zinc levels (likely due to impaired digestion).

Could you be at risk? I’ve created a handy Zinc Screen to help you determine whether or not you may be at risk for zinc deficiency. Give yourself 1 point for every symptom you have, then count up your total score:

Causes of Zinc Deficiency

It’s important to be familiar with the many other factors that can deplete one’s zinc levels, many of which are also common co-occurring conditions in those with Hashimoto’s. Possible causes of zinc depletion include:

  • Celiac disease and malabsorption syndromes: The absorption of zinc may be impaired by intestinal damage due to conditions such as celiac disease and other malabsorption syndromes.
  • Phytate-rich foods: Phytates found in grains, legumes, nuts, and seeds can bind zinc and prevent its absorption when they are eaten alongside zinc-containing foods.
  • Iron supplements: Taking iron supplements in conjunction with meals may also prevent the absorption of zinc from food.
  • Low stomach acid: A lack of stomach acid, which is common in those with Hashimoto’s, can prevent one’s absorption of zinc, as well as other nutrients.
  • High cortisol levels or excessive cortisol production: Zinc can become depleted with excessive cortisol production, which is associated with increased levels of stress, as well as adrenal dysfunction.
  • Certain diets: Many diets, including vegan, gluten free, Paleo, low-fat, high-protein, lactose free, low-carb, low-sodium and Standard American Diets, may incorporate less zinc-rich foods.
  • Medications: Certain medications, like synthetic estrogen and progesterone (found in birth control pills, which can rob us of our health), acid blocking medications like proton pump inhibitors (ie. Prilosec, Nexium, Omeprazole and other purple pills), and H2 receptor blockers such as Pepcid or famotidine, can deplete zinc levels.
  • Pyroluria and Social Anxiety: Pyroluria, also known as Mauve Factor or Pyrrole Disorder, is a genetic abnormality in which one produces an unusually high number of hydroxyhemopyrrolin-2-one (HPL) in their body. Pyroluria can cause shyness, introversion, and symptoms related to anxiousness and shyness, including social anxiety. Other classic symptoms include morning nausea or lack of appetite, poor dream recall, strange dreams or nightmares, depression, and a puffy, swollen face. It can be diagnosed by testing for pyrroles present in urine samples.The current scientific literature shows that HPL binds to vitamin B6 and zinc, resulting in the excretion of these nutrients via the urine in large amounts. As such, this condition has been linked to zinc deficiency and a greater need for supplementation. In fact, certified nutritionist Trudy Scott believes addressing zinc along with vitamin B6 deficiencies can prevent pyroluria and social anxiety. You can find out more about pyroluria on her website, as well as in her book The Antianxiety Food Solution.
  • Abnormal Eating Disorders: Research has associated zinc deficiency with reduced food consumption. Studies have suggested that increasing one’s zinc levels may benefit those with anorexia nervosa by correcting abnormalities in gamma-Aminobutyric acid (GABA) neurotransmitters and the amygdala, which are abnormal in anorexic individuals. Its effects on bulimia nervosa have also been reported, but research is scarce.
  • Chronic Fatigue Syndrome: Researchers have found that zinc levels were lower in those with chronic fatigue syndrome. Other studies have shown that zinc can be lowered by the presence of increased levels of pro-inflammatory cytokines such as IL-6.

Testing for Zinc Deficiency

Testing for zinc can be done through a standard blood test ordered by your practitioner. However, it’s important to note that some blood tests may not be accurate, as they do not indicate the level of cellular zinc. Additionally, signs and symptoms of zinc deficiency can be present, despite normal lab results.

As such, a liver function blood test may help to identify a zinc deficiency, which will present as low alkaline phosphatase (ALP) levels. (The optimal range for this enzyme is 70 to 90 IU/L). The Comprehensive Metabolic Panel by Ulta Lab Tests can check your alkaline phosphatase levels, as well as other markers related to liver health.

Advanced testing for vitamin and mineral deficiencies can also be done to help determine your body’s zinc levels. The SpectraCell Laboratories Micronutrient Test is a great option to consider, as it will check for multiple other nutrient deficiencies as well, including: vitamin A, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12, biotin, folate, vitamin C, vitamin D, vitamin K, calcium, magnesium, manganese, copper, selenium, vitamin E, and more!

(Interested in learning about other common nutrient deficiencies in those with Hashimoto’s? Check out my FREE eBook, Supplements to Subdue Symptoms.)

Dietary Sources of Zinc

Zinc can be found in food. Oysters have the highest concentration of zinc, but they are not typically considered an everyday food. Beef, liver, pork, lobster, and chicken are the next richest dietary sources of zinc, as it is easier to extract zinc from meat than from non-meat sources. (This explains why vegetarians also have an increased risk of zinc deficiency.)

Avoiding the consumption of alcohol, refined sugar, white flour, rice, and oxalate-rich foods, which are zinc-depleting foods, may also help you with zinc extraction.

Nonetheless, since zinc is not stored in the body, those with zinc deficiency, Hashimoto’s and other autoimmune conditions may want to consider zinc supplementation as part of their everyday regimen.


To address a deficiency in zinc, supplements may be utilized. However, I don’t like recommending one-a-day-type vitamins because they don’t consider how the vitamins interact with one another.

For example, vitamin C taken with iron improves the absorption of iron, while iron taken with zinc decreases the absorption of zinc. Thus, providing just the recommended dietary allowance (RDA) of zinc when only 50 percent of it will be absorbed is not effective in overcoming a severe zinc deficiency. Some vitamins and minerals need to be taken with food to promote absorption; others, on an empty stomach.

Furthermore, not all supplemental zinc formulations are created equally. I prefer the zinc picolinate version, such as the one made by Pure Encapsulations, because it is absorbed better.

I usually recommend doses of no more than 30 mg per day, unless you’re working with a practitioner who advises higher doses. To ensure proper absorption, zinc supplements should be taken with food.

I’ve also found that taking 500 mg of evening primrose oil, twice per day, improves the absorption of zinc.


Doses should be no more than 30 mg per day without your doctor’s supervision. This is because doses above 40 mg may cause a depletion in copper levels. Zinc supplementation can also deplete one’s iron levels.
In fact, in one study, taking 50 mg of zinc taken over ten weeks led to depletions in both copper and iron.

This may be beneficial in some cases, where one is copper toxic. If your alkaline phosphatase levels do not change despite starting zinc supplementation, this may indicate that there is an underlying case of copper toxicity that may need to be addressed. (For more information on having high levels of copper, check out the section on copper toxicity and the Copper Detox Diet in my new book Hashimoto’s Protocol.)

In other cases, however, taking too much zinc can produce a copper deficiency, and you may need to take supplemental copper. Symptoms of copper deficiency include anemia not responsive to iron supplementation, trouble with walking and balance, fatigue, and lightheadedness.

Please refer to your medical practitioner if you suspect you will need a copper supplement in addition to zinc, or if you may be at risk for abnormal copper levels.

The Takeaway and Next Steps

Zinc is a vitally important nutrient, playing a key role in over one hundred functions in your body, including proper immune system function, intestinal wall repairs, and tissue healing.

It also plays a vital role in TSH production and the conversion of T4 to T3. Depleted zinc levels, which are common in those with Hashimoto’s, can be the root cause of many of your symptoms, including poor wound healing, impaired taste and smell, thin, brittle, peeling, or white-spotted nails, a weakened immune system, allergies, frequent colds and respiratory infections, diarrhea, unexplained weight loss, a lack of alertness, and open sores on the skin. If any of these sound familiar, think about zinc!

As many causes of zinc depletion are common co-occuring conditions in those with Hashimoto’s, increasing your zinc levels may help reduce your symptoms and put your autoimmune thyroid condition into remission.

While you can absorb zinc from dietary sources, it’s important to remember that zinc is not stored in the body, so I recommend adding a zinc picolinate supplement to your daily regimen to boost and maintain your zinc levels. You may also consider taking it with evening primrose oil for better absorption. Again, if your zinc levels do not improve after starting supplementation, you may wish to consider looking into whether you have copper toxicity.

I hope this brings you one step closer to putting together the puzzle pieces of your symptoms. Remember, every effort spent towards optimizing your health is a step towards getting and feeling better. I wish you all the best on your healing journey!

P.S. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by going to www.thyroidpharmacist.com/gift. You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook!

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Hashimoto’s: The Liver and The Thyroid

Hashimoto’s: The Liver and the Thyroid

Hashimoto’s can cause a host of problems all over the body, but one place in particular where we can see it’s influence is on the liver and gall bladder.

In this post we explore these relationships and explain why a healthy liver is so important for healing your Hashimoto’s.

With Hashimoto’s The Liver and Thyroid Affect Each Other In Many Areas

The body is not a machine, like our earth it is a group of interacting ecosystems that all talk to one another and influence each other in both good and bad ways.

The liver and the thyroid are a perfect example of this. Here is a brief breakdown of how they interact:

* 60% of thyroid hormone is converted from T4 to T3 in the liver. Both T3 and T4 are glucoronidated and sulfated there. (More on that in a minute).

* Thyroid hormone influences the way that cholesterol and other lipids are synthesized and broken down (and where does this happen? – yes, the liver). With Hashimoto’s and hypothyroidism, this is often slowed down resulting in high cholesterol and other lipids like LDL and triglycerides.

* Thyroid hormone affects detoxification pathways in the liver and affects insulin growth factor and cytochrome P450 enzymes which metabolize lots of drugs and environmental toxins. When this slows you can have toxins build up.

* On the autoimmune side, research has shown a link between autoimmune thyroid and autoimmune liver diseases.

*Very high levels of thyroid hormone (T3) can raise bilirubin levels and can actually be toxic to the liver because it damages mitochondria.

How Does the GallBladder Fit In to This?

The liver has several pathways through which it metabolizes hormones, filters toxins, and cleans the blood. Byproducts from these processes are dumped into the gall bladder to help get them out of the body.

Low thyroid function slows down this whole process, making the liver and gall bladder sluggish and congested and helping to make gallstones.

Gallbladder x-rays in hypothyroid patients can show a bloated gall bladder that contracts sluggishly. This slows down the flow of bile which can lead to slower breakdown of fats and cholesterol and other toxins that are broken down in the liver.

This whole process can also lead to the formation of gall stones. Many people with Hashimoto’s have gall bladder issues.

How Is Thyroid Hormone Converted in the Liver?

Thyroid hormones are converted into their usable form in the liver (60% happens there), you can see how low thyroid function can create a vicious cycle.

Hypothyroidism messes with liver function and fewer thyroid hormones become active. So it goes until you have all of the common symptoms of too little thyroid hormone: fatigue, brain fog, joint pain, hair loss, weight gain, depression, etc.

Thyroid hormone is converted primarily through 2 processes:

Glucornidation and sulfation, let’s break these down:

According to Dr. Datis Kharrazian, DC, these processes are supported in the following ways:


Glucoronidation is an important process for converting thyroid hormone.
This pathway is supported by B vitamins, magnesium, and glysine,


Sulfation involves binding things partially broken down in the liver with sulfur containing compounds. It is one of the major detoxification pathways for neurotransmitters, toxins, and hormones (like thyroid hormones).

Vitamin B6 and magnesium are important for sulfur amino acid metabolism, as are foods containing sulfur such as: eggs, cheese, meat, poultry, nuts and legumes.

Its important to choose animals products wisely, buy organic whenever possible because organic foods have far fewer toxins like antibiotics, hormones, and pesticides which can all cause problems of their own.

Another important point about sulfating is that it requires sulfate which is often poorly absorbed by the digestive system, especially by people with Hashimoto’s who often suffer from intestinal permeability or leaky gut syndrome. Sulfate is the oxidized, inorganic form of sulfur produced by an oxidation step called (you guessed it) sulfoxidation.

This step is made possible by an enzyme that is called sulfite oxidase which uses the essential mineral molybdenum, .

 Problems with sulfoxidation can be seen in people who are sensitive to foods that contain sulfites (garlic) or dugs and food additives (in dried fruit and herbs, preservatives, in salad bars used to keep vegetables looking fresh).

(These people may also have an abnormally strong odor in their urine after eating asparagus. For these people one should consider molybdenum supplementation or organic sulfates like sodium sulfate or magnesium sulfate.)

The Emotions of the Liver & Gall Bladder

In Chinese medicine, we view interactions in the body in the context of body, mind and spirit. This can be really helpful to see how these physical problems can affect you emotionally and psychologically.

In the book, Between Heaven and Earth by Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., the liver is described as something like a military commander in the body. It formulates tactics and strategies, moving blood and energy (qi) throughout the body.

The thyroid is part of the endocrine system which is viewed as qi and is derived from the yang energy of the kidneys. So the ancient Chinese recognized this relationship and how important one is for the other. The liver needs that qi to have the energy to do its job, and if it is clogged or blocked it can’t facilitate the movement of that energy throughout the body.

Anger, Irritability and a Short Fuse Are Symptoms of Liver Issues

When the liver gets stuck or clogged, the most common emotion that people experience is anger. This can be directed outwardly at people you know (usually people closest to you: family, co-workers, or friends), or this anger can be directed inwardly and result in depression and feeling of self-hatred and low self-worth. Or sometimes you have a combination of these two.

It is also interesting to note that in Chinese medicine the nervous system, tendons and ligaments and the eyes are thought to be part of the sphere of influence of the liver. So many people with Hashimoto’s also have issues in all of these areas: eye problems, tendon issues, and cognitive issues affecting the brain.

Gall Bladder Issues Make You Unable to Make Decisions

The Gall Bladder stores and secretes bile, this stimulates flow through the stomach and intestines and is very important in helping us to absorb and eliminate different foods as well as different ideas and concepts.

So proper bile flow and production also help us with proper judgment, clear thinking and decision making. If there are Liver/Gall Bladder issues we can end up taking actions without thinking them through, or making decisions and not following through on them or simply getting stuck, unable to decide what to do.

How Can You Help the Liver, Gall Bladder and (Indirectly) The Thyroid?

Here are some important herbs for helping the liver and gall bladder.

Ginger: this common food contains chemicals that have been shown to increase bile secretion and to reduce cholesterol levels by up regulating an enzyme responsible for bile acid production (cholesterol-7-alpha-hydorxylase).

Dandelion: The root of this common weed promotes the production of bile and its delivery to the gall bladder. It causes the gall bladder to contract and release bile.

Milk Thistle: This herb increases the solubility of bile and has been shown to significantly lower cholesterol concentrations in the gall bladder. It has potent anti-oxidant activity which supports detoxification and it prevents depletion of glutathione in the liver, which is often depleted in people with Hashimoto’s.

 It also has anti-inflammatory properties and it promotes protein synthesis to replace damaged liver cells.

Panax ginseng:This herb has been shown in several studies to have numerous positive impacts on liver function. It has been shown to reverse fatty liver in animals and can be really helpful in cleaning toxins out of the liver. It also has really important benefits for the immune system like promoting Kupffer cells (specialized immune cells located in the liver) and can be beneficial in balancing the immune system by increasing key proteins like IL-8.

Herba sargassi, Laminaria Kun Bu: These seaweeds have important detoxification properties and can be used to treat metabolic toxicosis with arthritis, rheumatism, dermatitis and psoriasis. They are quite mild and have very few if any side effects. In addition, they are rich in trace minerals and are helpful in reducing swelling, particularly in the lymphatic glands.

A word of caution with seaweeds: They contain iodine which can be problematic with some Hashimoto’s folks.

Fructus Gardeniae: This herb is the seed pod of the gardenia plant. It has potent anti-bacterial and anti-viral properties and can be used to reduce liver and gallblader congestion and infections.

Caution: Liver infections can be quite serious, consult a trained physician if you suspect that you have any form of hepatitis or liver disease.

Rhubarb Root: This herb is a potent laxative that can be used to treat acute gall bladder and pancreatic infections. It has potent anti-bacterial, anti-fungal and anti-viral properties.

Dosage is critical with this herb and too much can cause gastric pain and diarrhea. Never use during pregnancy or lactation or with gout, hemorrhoids or oxalic acid stones. Consult a trained professional before using this herb.

Herbs That Help With Anger and Irritability

There is a very effective herbal formula in Chinese Medicine whose name is translated as Rambling Powder. The name comes from the title the first chapter of a book by Zhuang Zi, “Rambling Without A Destination” that includes stories about wandering freely with an open mind. It is a reference to how this combination of herbs can help one feel less constrained emotionally, feel happy and less stressed.

It has several variations and contains a number of herbs that are very helpful for the liver including buplerum, mint, atractylodes and more. With modifications, it has also been used successfully to treat eye issues, hypertension, hepatitis, anemia, depression, irritability and anger.

Hashimoto’s Requires A Multi-Prong Approach

Hashimoto’s has so many moving parts and affects so many systems of the body that you really need to have a treatment strategy that looks at all these different areas and gives you solutions for all of them.

That’s why I developed my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In in we explore the 5 major systems of the body and learn how they impact us physically, emotionally and spiritually.

Because true healing requires more than simply taking a few pills or herbs. It requires a complete overhaul of your body, mind and spirit. And it is a tremendous opportunity for growth and for healing all aspects of your life.

Between Heaven and Earth, Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., Ballantine Books, New York, 1991

Chinese Herbal Medicine Formulas and Strategies, Dan Bensky & Randall Barolet, Eastland Press, 1990

Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Datis Kharrazian, DC, Morgan James Publishing, 2010

The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman and Robert D. Utiger, 2005 Lippincott Williams and Wilkins

Severe hyperthyroidism induces mitochondria-mediated apoptosis in rat liver.
Upadhyay G, Singh R, Kumar A, Kumar S, Kapoor A, Godbole MM.
Source: Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Laukkarinen J, Kiudelis G, Lempinen M, Raty S, Pelli H, Sand J, Kemppainen E, Haglund C, Nordback I. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007 Nov;92(11):4260-4. Epub 2007 Aug 28

Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism. Hepatogastroenterology. 2000 Jul-Aug:47(34):919-21

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What is Hepatitis C?

The Hepatitis C Virus infects the liver and it can spread to other body tissues such as the thyroid gland. Once inside the thyroid gland, it multiplies and may cause Hashimoto’s disease. Hepatitis C has also been found to trigger arthritis, diabetes, autoimmunity to the liver, Sjogren’s syndrome, and autoimmunity to the kidney. Chronic infection of the liver causes liver cirrhosis and even liver cancer.

What are the symptoms of Hepatitis C?

This can be the tricky part because some people don’t have any symptoms. The virus could be silent for many years before you get symptoms. You could have Hepatitis C along with Hashimoto’s disease and not know it. The main symptoms include:

Abdominal pain
Yellowing of your skin and eyes (jaundice)
Loss of appetite
Swollen blood vessels that look like a web
Rectal bleeding
Fluid in your abdomen
Slurred speech
Weight loss
Swelling in your legs
Itchy skin
Bruising and bleeding easily
Dark-colored urine
Muscle aches

How do you get Hepatitis C and how is it tested?

This virus is transmitted by sexual intercourse, blood transfusion, or sharing drug needles with someone who is infected. Antibody tests to Hepatitis C are readily available through most commercial labs such as Labcorp.

One of the things I will see on blood testing is elevated liver enzymes including AST and ALT in Hepatitis C infection. I’ll also look at a CBC (complete blood count) which usually reveals elevated lymphocytes indicating viral infection. Inflammatory markers such as c-reactive protein and erythrocyte sedimentation rate may also be elevated. The ANA (anti-nuclear antibody test) has been shown to be positive in up to 33% of cases.

How does Hepatitis C trigger Hashimoto’s disease?

At the time of this writing, the exact cause is unknown but there are a few different theories. These include triggering the immune system to attack thyroid cells when the Hepatitis C virus is actively infecting the thyroid gland. The immune system may be tricked into attacking thyroid cells instead of the virus.

We do know that the Hepatitis C Virus can leave the liver via the bloodstream and infect the thyroid gland. It can remain there in a chronic state resulting in autoimmunity and inflammation in the thyroid gland.

How is Hepatitis C treated?

Interferon is the standard treatment but using interferon can actually trigger Hashimoto’s disease. It is recommended that patients with Hepatitis C be tested for thyroid antibodies prior to interferon treatment. Elevations in thyroid antibodies prior to interferon treatment are a big risk factor for developing Hashimoto’s disease.

There are a number of natural agents that may work well for the Hepatitis C Virus. These include:

Shisandra berry
Licorice root
St. John’s Wort

Another important factor is to focus on improving glutathione levels in the liver with the following:

Whey protein
Milk thistle

Glutathione itself can be taken as a supplement in the liposomal or reduced form, but make sure it is a quality brand with good absorption.

The other important factor is to help with “liver congestion” due to all the inflammation and damage the Hepatitis C virus does to the liver. These compounds can help:

Ox Bile
Beet root powder
Black radish

In addition to fighting the Hepatitis C virus and supporting the liver, we must also use our normal protocols for viral infections inside the thyroid gland in patients who have Hashimoto’s disease as well. The focus is reducing inflammation inside the thyroid gland, reducing viral activity, and balancing the immune system. These protocols are unique to each patient so I won’t get into them here. Your functional medicine practitioner will identify the best treatment approaches for your Hashimoto’s disease as well as the Hepatitis C virus.

This can result in improvement in thyroid antibody levels and thyroid function. If you have had Hepatitis C virus then I would definitely recommend getting tested for Hashimoto’s disease. Or if you have Hashimoto’s disease and potentially have some of the risk factors for Hepatitis C, then you may want to get a hepatitis panel blood test to rule this out.

Is the liver affected by thyroid function?

Nonalcoholic Fatty Liver Disease (aka NAFLD) is a somewhat common liver condition that affects about 25% of Americans. A healthy liver naturally contains some fat, but NAFLD is a condition where there is an excessive build- up of fat. Alcohol consumption can be one reason for increased fat in the liver, but not in the case of NAFLD. Instead, it’s caused mainly by obesity, diabetes, elevated cholesterol or poor dietary choices.

NAFLD can be mild and symptomless, but it can also cause problems such as fatigue, swelling in legs, nausea and other non-fatal conditions. There is even the possibility that it can progress to liver cancer or liver failure over time. So it’s important to know if you have it in order to stop the progression.

Beyond the known causes previously mentioned, NAFLD may also be linked to low thyroid function. A large study was published recently that looked at over 9000 people who were monitored to see if they developed NAFLD over the course of 10 years. Researchers measured everyone’s thyroid levels (free T4 hormone and TSH) at the start of the study and at the end.
The researchers found that the higher the thyroid hormone levels were to start, the lower the risk of developing NAFLD. Patients who were diagnosed with hypothyroidism had the highest risk. Researchers noticed that people who were considered to have “normal thyroid” tests, but were on the lower end of normal, also had increased risk of developing NAFLD.

Patients who had elevated TSH levels, the standard test used to diagnose hypothyroidism, (high TSH = low thyroid hormone) had a higher risk for NAFLD. The overall trend was that the more “normal” the thyroid and TSH tests were, the lower the person’s risk of developing NAFLD.

This study is interesting because it links liver health to thyroid levels fairly convincingly. Anyone with low- normal thyroid levels, hypothyroidism or Wilson’s Temperature Syndrome, should be aware of this connection and have their liver checked out (liver enzyme tests) by their physician. The reverse is also true- if you have liver problems, you should check to see if your thyroid is sluggish. By taking your temperature, you will see whether or not you have a slow metabolism. If so, standard thyroid tests will help you see whether you have hypothyroidism or Wilson’s Temperature Syndrome. Instructions for taking your temperature are HERE.

J Clin Endocrinol Metab. 2016 Aug;101(8):3204-11. Thyroid Function and the Risk of Nonalcoholic Fatty Liver Disease: The Rotterdam Study. Bano A1, Chaker L1, Plompen EP1, Hofman A1, Dehghan A1, Franco OH1, Janssen HL1, Darwish Murad S1, Peeters RP1.

Hyperthyroidism is a condition where the thyroid gland is overactive and produces too much thyroid hormone. A frequent treatment for hyperthyroidism is antithyroid medications, either Methimazole or Propylthiouracil. It is known that both medications, as well as hyperthyroidism itself, can affect the function of the liver, causing increases in blood levels of markers of liver function know as liver function tests. If the increase in liver function tests are due to the hyperthyroidism, treating the hyperthyroidism will cause the liver function tests to return to normal and the liver is not damaged. However, if the increase in liver function tests is due to the antithyroid medications, the medication needs to be stopped to avoid damage to the liver, and options of radioactive iodine therapy or surgery need to be considered to treat the hyperthyroidism. The effects of hyperthyroidism on the liver are not well understood. This study examined the risk factors for abnormal liver tests in patients with hyperthyroidism.

Lin TY et al. Incidence of abnormal liver biochemical tests in hyperthyroidism. Clin Endocrinol (Oxf ) 2017;86:755- 9. Epub March 9, 2017.

This study looked at the UCLA electronic medical record database of over 1500 patients from 2002 to 2016. Nearly 80% of the patients were women, 60% were Caucasian, 14% wereAsian, 9% were African-American and 14% were Hispanic. These patients were newly diagnosed with hyperthyroidism. The liver function tests performed within 6 months of the diagnosis were reviewed. Patients on medications that can affect the liver or patients who had liver disease prior to developing hyperthyroidsim were not included.

Levothyroxine-induced liver injury followed by complete recovery upon cessation of the drug: a case report

We report a case of a 34-year-old woman who developed post-thyroidectomy hypothyroidism requiring thyroid replacement. She was initially treated with levothyroxine; however this led to DILI, which resolved upon cessation of the drug. The patient’s hypothyroidism was managed with triiodothyronine, and she responded favorably. This case report adds to the medical literature in two important points. First, levothyroxine can rarely lead to liver injury, which is a significant adverse effect about which clinicians should be vigilant. Second, no invasive liver biopsy was required to support the diagnosis in this particular case, highlighting that a less invasive approach in DILI can occasionally suffice in securing the diagnosis.

DILI has been implicated in association with over 1000 drugs and herbal products. DILI can be classified in several ways. Initially, classification is based on clinical presentation (hepatocellular, cholestatic, or mixed injury). Occasionally, a liver biopsy is required to make the diagnosis and assess the extent of damage. Histological findings include hepatitis, cholestasis, and steatosis. A liver biopsy was not obtained in this case, because results of testing for an alternative cause were negative, and the patient’s liver enzymes normalized immediately after the drug was discontinued. In general, requesting liver enzyme tests at baseline and for monitoring purposes is reserved for common culprits such as isoniazid and methotrexate. Levothyroxine-induced liver injury is an exceedingly rare adverse effect. In our patient’s case, we attributed liver injury to this drug on the basis of the facts that drug exposure preceded the onset of liver injury, underlying liver disease was excluded, cessation of the drug led to improvement in liver enzymes, and symptoms recurred rapidly when the patient was rechallenged. Indeed, a total score of 8 on the Naranjo Adverse Drug Reaction Probability Scale (Table 2) was observed, supporting a causal effect. The Roussel Uclaf Causality Assessment Method diagnostic score was 11, suggesting that an adverse drug reaction was highly probable. The improvement in liver enzymes upon cessation of the drug also argues against transaminitis due to the hypothyroidism itself. Sepsis with “bystander” hepatitis is a reasonable differential diagnosis to make because the patient did present with abdominal pain and fever. However, we considered it less likely in view of the transaminitis that occurred upon rechallenge of levothyroxine when the patient was clinically well and her liver enzymes had begun to normalize.

Table 2 Naranjo Adverse Drug Reaction Probability Scale scoring system

The patient had a disproportionate elevation in serum aminotransferases compared with AP. Her serum bilirubin was elevated, and her serum albumin was reduced. This pattern may indicate hepatocellular injury (hepatitis); however, the low albumin level can be attributed to its being a negative acute-phase reactant, and the improvement occurred after the resolution of the liver injury.

A similar pattern of levothyroxine-induced liver injury has been reported . Kawakami et al. speculated that the complex of levothyroxine as the hapten and liver-related macromolecules in the body of the patient in their case report might have acquired antigenicity, which subsequently resulted in the liver injury. Kang et al. interestingly showed that after their patient experienced DILI due to levothyroxine in tablet form, the same was not observed when the patient was commenced on levothyroxine in powder form. This may suggest a casual effect due to the additives contained in these preparations. The mechanisms behind levothyroxine-induced liver injury therefore remain unclear . Among patients in all three previous reports and our patient, none underwent liver biopsy, and in all cases, liver enzymes normalized after cessation of the drug. We opted not to offer liver biopsy. Experts may argue that DIAIH, which can recur at a later stage, cannot be absolutely excluded without a liver biopsy. There is a lack of data comparing these patients with those who have autoimmune hepatitis . Our patient did not have any positive autoimmune antibody tests results and required no immunosuppression, both of which argue against DIAIH, albeit that some patients with DIAIH recover without the need for immunosuppression. Treating our patient’s hypothyroidism with triiodothyronine was effective and did not lead to liver enzyme derangement.

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