Biological changes and symptoms of hypothyroidism and liver connection

1. Lipid metabolism is affected, higher total cholesterol levels seen and

other lipids like LDL and triglycerides.
2. Metabolism of cholesterol into bile salts lowered and consequently fat
is not properly digested. Fat soluble vitamins (A, K, D and E) and the
essential fatty acids are not properly absorbed.
3. Problems with detoxifying hormones such as excessive oestrogens and
other toxic molecules which may increase the risk of cancer and
increases inflammation in the body
4. Poor sugar control. Hypothyroid people store less glucose in the liver as
glycogen and are more prone to hypoglycaemia and insulin resistance
(see my previous blog). Insulin growth factor (similar to insulin and
secreted by liver) is reduced.
5. Not efficient production of copper binding proteins in liver causing
metabolic syndrome problems (obesity, oestrogen dominance, insulin
resistance)
6. The liver plays a part in maintaining normal iron levels and when it is
sluggish due to hypothyroidism, levels of iron become low. Dark circles
under the eyes and tiredness may indicate low iron levels in the body.
7. Non- alcoholic ‘Fatty liver’ (not necessary in an overweight person or
person who drinks alcohol) represented by a reduced hepatic clearance
and elevations in the amino transaminases. It is seen as build-up of fat
and scarring in the liver. Nutrients such as choline, inositol, SAMe and
betaine may help with fatty liver. Fatty liver may progress to liver
scarring, damage and liver cirrhosis. There is a correlation of non-
alcoholic liver disease and hypothyroidism, it was seen in 26 – 36% of
patients with hypothyroidism in a study (5).
8. Production of SAMe is reduced in liver which is linked to depression,
high histamine (lots of allergies), insulin resistance, lowered
glutathione levels and poor detoxification in liver, especially of
excessive oestrogen.
9. Hyperammonaemia (increased ammonia load) can be seen in severe
untreated hypothyroidism as liver changes ammonia (a toxic by-
 product of protein metabolism) into urea, which is then excreted in
urine.
10. Poor detoxification of toxic molecules resulting in muscle pain,
headaches, migraines and feeling tired

MUSCLES

The pathogenesis of myopathy in hypothyroidism is not well understood. Thyroid hormones

have a significant influence on cellular metabolism, and their deficiency causes impairment of
the normal functioning of the cell. Thyroxine (T4) deficiency leads to a reduced
mitochondrial oxidative capacity, abnormal glycogenolysis and an insulin resistant state of the
cell. This leads to selective atrophy of type 2 muscle fibers (fast-twitching type) as they are
dependent on glycolysis for energy causing the slowing of muscle contraction seen clinically
in patients with hypothyroidism. Muscle hypertrophy ensues as a result of this, which is
believed to be a compensatory response that happens from the accumulation of
glycosaminoglycans in the muscle. Increase in connective tissue and muscle fibers also
contributed to this hypertrophy. There is also a decrease in muscle carnitine in patients with
thyroid dysfunction causing myopathic symptoms. The muscle involvement in
hypothyroidism is caused by alterations in muscle fibers from fast-twitching type 2 to slow-
twitching type 1 fibers, deposition of glycosaminoglycans, poor contractility of actin-myosin
units, low myosin ATPase activity and low ATP turnover in skeletal muscle.

It has been noted that the degree of muscle weakness does not always correlate with the
severity of thyroid hormone deficiency and this suggests that besides impaired muscle
function, structural muscle injury might have a role in the pathogenesis of the myopathy in
some cases. Muscle cell membrane permeability changes can lead to serum muscle enzyme
elevations in the absence of symptoms or structural abnormalities, and reduced clearance of
these enzymes can contribute to the muscle injury as well. Animal studies have shown the
involvement of thyroid hormone in regulating gene expression of skeletal muscle proteins like
myosin ATPase strengthening the role of thyroid hormone deficiency in the pathogenesis of
hypothyroid myopathy.