Another reason to shun T4 meds—your liver

Though this page was originally written in 2009, it’s been updated to the current day and time. Time does not change that your liver “may” be negatively effected by T4-only meds, or even being underdosed on NDT or T3. 

I’ve been noticing several articles coming out about a strong association between hypothyroidism and a twice the risk of liver disease and liver cancer, especially in females.

And then it dawned on me: another strong reason patients end up up playing basketball with their trash cans using bottles of Synthroid, Levoxyl, Levothroxine or Eltroxin, and being replaced with a working desiccated thyroid or T4/T3 at the same time.

In other words, continued hypothyroidism (which being on T4-only meds has promoted) and undiagnosed hypothyroidism (because of the inadequacy of the TSH lab test) can ‘potentially’ promote the development of nonalcoholic steatohepatitis, a more severe Fatty Liver disease, if these articles are right. The next progression is liver cancer, aka hepatocellular carcinoma (HCC).

Even worse, the study revealed that women who had been hypothyroid for more than 10 years had a threefold higher risk of liver cancer compared to women without a history of thyroid disorders. This will make you pause when you consider how many reports there are of patients having hypothyroid symptoms for YEARS with a normal TSH…and a clueless, TSH-worshipping doctor.

And if reading this bores you, understand that your liver is a HIGHLY important gland that you can’t live without. It plays a key role in detoxifying the toxins you ingest and breath in daily (including smoking), besides being a major fat burner.  Make the liver diseased, and you become a breeding ground for toxins, the rise of other diseases…then death.

The solution? Patients are running from TSH and T4-only doctors, finding a doctor to put them on a working desiccated thyroid, or T4/T3, and avoiding the most common mistakes of dosing.

P.S. The original report came out in the May journal issue of Hepatology  (the latter is now non-working–here’s the correct place it was to go.) (published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases).  Similar results were also reported in the Journal of Gastroenterology and Hepatology 2005.

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Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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54 Responses to “Another reason to shun T4 meds—your liver”

  1. Gayle says:

    I have been on Armour for 10 years. Lately not working as well. Went to new doctor 2 months and ran tests -my adrenals are very low! He switched me to NP and added Adrenal Vive and Adrenal-Cortez Fractions Fractions. For the last 2 months my hair is falling out! Have read this is common with NP for the first couple months, but I am concerned. I have lost a lot of hair!!! Anyone else experience this? And if so what worked for you?

  2. Tabatha Howell says:

    How would I know if damage to my liver has been done I do not have a thyroid I have been told I have a fatty liver they said I need to loose weight. But I have had stomach issues and pains in the upper part of my stomach

  3. Kara says:

    It’s been almost 10 years since I started using synthroid, but things are totally changed last 2-2.5 years. It’s probably also I gave birth 25 months ago. After being insulted by the multiple doctors, finally I went to a naturopath doctor and he told me that my thyroid levels are not optimum. We decided to try NDT. Even though I was very happy, I started experience very high blood pressure when I was on NDT, had to stop and continue to use synthroid again. Things became better (at least no more extreme high blood pressure levels), but I wanted to try again. Unfortunately I got the same results. I don’t understand why my body reacts like that. I don’t even know what should I do next. Adding T3 to my synthroid? Have you come across anything like that? I really appreciate some suggestions.

  4. Julie says:

    Here is the link to the original study done in the article.

  5. Miralyn says:

    In 2014 I went to the doctor for a routine check up and my NP asked me a series of questions and the NP told me of a study she and her husband ( physician) did a year earlier involving 100 women ages 30-50 who complained of hypothyroid symptoms

    At the end of the day I was on .75 mcg synthyroid and an appetite suppressant because according to her I would have the metabolism of an 18 year old so I began taking the 2 meds and for the first three days I was so incredibly sick but after that I was ok.

    I took that combination of meds for 6 months and I lost 30 lbs in the first month however I was on my way to work and felt like I was having a heart attach so I immediately reported to her office while there she did a ekg on my heart and took me off the appitite med (phen-Phen) so I continued the synthyroid but I felt terrible so I decided to get a second opinion and found out that that I NEVER needed any meds for my thyroid

    Now 4 years later I have not only put the weight back on I simply cannot loose weight and I now display ALL the symptoms of hypothyroid and have been diagnosed with a NAFL

    Where do I turn to now all the doctors in my area want to push meds to get cash, where are there doctors that will actually list and do their best to help you?

    • The problem is that no doctor is totally caught up with all we know–the latter as shown on Stop the Thyroid Madness and in the books.So you try to find the best doc you can, but expect to guide even the better one by reading and learning from STTM.

    • Tamie Nicholson says:

      What is NAFL if you don’t mind. Yeah i told my finace that you could line up 5 doctors in a row and they would all give you a different opinion and it’s sad. If it was them, or one of there family members suffered from a thyroid disease then i think they would do everything they could to help them , while it’s unfair to us. I have had many nodules and cysts on my thyroid for over 7 to 8 years and everytime they do an ultrasound ( because they know things tests like that bring them alot of money) but everytime i get one done a new nodule and cysts always shows up, and everytime i swallow it feels like i have something down my throat. I was unable to work as of last year due to alot of medical issues including alot of GI issues and i have 2 tests coming up next month. When i had good insurance they wanted to send me to an edcrindologist, but workung as a single mom in the medical field it was shyed upon taking off work and I’ve lost so many jobs because of it and it’s not fair because my health is more important. Now that I’m unable to work I’m stuck with some lousy state insurance and it really really stinks. They did another biopsy and said it came back non camcerous but i fall within the 1 to 8 percent change of thyroid cancer. My PA which isn’t even a physician thinks she’s trained to treat me for my thyroid and I’ve never been put on any meds and I’ve always been a small person and all of a sudden i put on like 45 pounds out of nowhere and i promise you it’s not from eating because of my GI problems i can barley eat , it hurts me bad, but i eat like once a day because i can’t go without food and hopefully i will find out what is going on soon. My PA said that my bloodwork comes back fine and I’ve heard a million times it doesn’t always show up in bloodwork. I’ve never ever weighed over 135 to 140 lbs in my life or have ever had to watch my weight and this came on so sudden and its alarming. I called the health coordinator over were i see the PA at and she told me that she’s gonna try and get me a referral into an endocrinologist because i explained to her i was a former nurse and she’s not at all trained to treat my condition. My thyroid is actually covered and that’s not normal at all. When i pick up my high blood pressure meds the pharmacist told me his wife got one opinion from one dr and they couldn’t do anything for her, so they went to another dr and ENT because they are the ones he said that did her surgery. Only one half of her thyroid was covered and just to be on the safe side they removed her whole thyroid and she takes one pill a day to regulate what her thyroid would normally do and the pharmacist said she is doing wonderdul, he also told me i shouldn’t haft to live this way. I never did get that phone call from the health coordinator’s boss , so they will be getting another call from me this week because thyroid issues run highly on both sides of my family and they have had to have things removed , but when it comes to me this insurance is basically worthless. They will pay and charge you for major tests but don’t wanna help you otherwise and I’m gonna sick my disability attorneys on them if something isn’t done soon because this last year has been a horrible one. Because they are all state dr’s they don’t have very many good ones to choose from, but i found out that they have a regular MD in my hometown and maybe he will be better because this is a horrible way to live. My GI issues have been going on for alongtime and have gradually gotton worse and my insurance basically only pays for vitamins and it’s a joke, and when I’m trying to get disability because my Dr’s don’t want me working right now i guess they think your made of money and they keep on increasing the prices of meds and tests and different drs have told me different things and it’s just crazy. Sorry about the long message , but i wish you all the best wishes in the world and i will pray for you and i hope i get answers soon myself because I’m not the same person at all that i was last year and mentally I’m always a positive happy person but it takes a toll on you mentally and physically. God Bless you and your family and i hope you get thr help you need and answers asap. Any advice would be helpful, and could you tell me what synthroid is used for please and thank you.

  6. Martha says:

    At this point I am willing to ditchh synthetic meds and gofor a natural approach. It would be a religion to manage and get my doctor onboard but definitely worth it!!

  7. Nancy says:

    I had a total thyroidectomy due to Thyroid Cancer in 2011. My endocrinologist at that time had me on Synthroid. Well, after months on it, my liver enzymes were elevated. I did some research and asked to be put on Natural dessicated meds, like Naturethroid or Armour. She didn’t listen. So, I dumped her as my Dr. and went to a Dr. that put me on Natural dessicated meds. By my next lab check up, my liver enzymes were back to normal!
    I am feeling better and am living proof about this! We have to be our own self advocates when it comes to our health. Don’t ignore what your body is telling you!

  8. Melissa says:

    Dr Westin Childs Arizona. Find him on Facebook. He will prescribe T3 if need be. If I could have him treat me I would. Im in Australia and struggling myself habe liver pain, insulin resistance and on diabex now for 8weeks. Was on T4 for 2 yrs… liver pain began when I started taking it… Ive just figured this out now! Im trying to find a better endo here… hard to come by. I have different inconsistent answers…This will be my 3rd endo…all they want it to stick you on T4….it hasnt helped. I fear liver cancer. I was diagnosed with fatty liver.

  9. Rachel says:

    As someone whose been chasing my tail for various symptoms the past 10 years, my liver is one of them. Diagnosed with NAFL in 2014 it knocked me off my feet. I’ve been a conscientious eater and athlete most my life. My enzymes are elevated and my gastroenterologist even said that although it wasn’t off the charts it is high for a woman. Fast forward to Oct 2016 and I had a total thyroidectomy from Papillar Thyroid Cancer Stage 3. Most doctors do not acknowledge the link between the liver and the thyroid. Time will tell if my hormones once under control if it improves my liver function. I’m getting ready to go on NDT after a month or two has passed from RAI treatment this week. Best regards to all you!

  10. Denise says:

    Janie, i am a product of warped bad thyroid genes. Not sure where to start and have very little faith in $$$ drs $$$ so where do i beging to realighn my health? I have gaines 50 lbs in the past year with no change to my diet.just asking where to start. I have seen so many in my family suffer on pharm medications

    • Hi Denise. Stop the Thyroid Madness is where you start and here’s a good page: Also the revised STTM book.

    • Lorri says:

      I gained over 100 lbs in like 7-8months back in 2008. Drs had no idea why. Well then one evening I had some problems like maybe I was having a light stroke. My husband took me to the hospital and they did a c-scan and found a tumor.
      There were no Drs I. Ft Smith Ar that could remove it. I was sent to a specialist in Little Rock Ar. Over 100 miles away and he removed what’s called Rathkes cleft pouch cyst. It had grown into my optic nerve leaving my eye sight damaged in my right side. Also I now take medicine every night to control my brain fluid level. It drains off without it.
      Also I now will have breast milk the rest of my life and had a hysterectomy when I was young.
      Some can be removed through your nasal if caught in time. Mine the had to do brain surgery and open my skull as they said.
      It was on the pituitary gland and that’s controls all your hormones and of course the thyroid. This is why I’m writing this. Please ask to have a scan of your pituitary gland. I don’t want anyone to go through this surgery. They say it starts at birth. Read up on Rathkes cleft pouch cyst.

  11. Hi I have been on thyroxine for over 10yrs and I also have a fatty liver is there anything you can suggest I can do to help this please my doctor isn’t helping I was thinking of going to a naturopath to see if they can help could you please advise me what to do.

  12. Greg says:

    The article you quote establishes a link between hypothyroidism and liver disorders. Your claim that this is caused by levothyroxine is *consistent* with the article, but so is the claim that the hypothyroidism itself leads to liver issues.

    I should also note that not only has a link between levothyroxine and liver disorders *not* been established in the article, but your claim that there is a *causal* link is a very strong claim to make. Causal links are notoriously difficult to establish in science. I would be very careful about making such claims, especially when it may cause people to neglect their medical treatment.

    • Hi Greg. The reason this old blog post mentions a link between the two is based on the reports of many hypothyroid patients over years who found themselves with fatty liver disease while on T4-only, yet saw it go away once they got on an optimal dose of NDT.

      So when studies come up (May journal issue of Hepatology, published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases, and similar results reported in the Journal of Gastroenterology and Hepatology 2005), and when we see reports of liver issues in a lot of patients on T4-only which seem to go away while on optimal amounts of NDT, we think this is important to mention for anyone to consider.

      And Greg, “science” has failed thyroid patients repeatedly in certain areas. There is plenty of “science” which implies that T4-only is a satisfactory treatment, yet when we hear from patients all over the world who for years and years report problems on those same meds, we lose respect for much of so-called “science” in this area.

      Finally, no one is recommending people to neglect their medical treatment. Instead, the information in this article points to considering a different thyroid treatment with NDT (or even adding T3 to one’s T4) based on what having direct T3 in one’s treatment has done for people in such a positive way.

  13. carolyn says:

    Hi. I have been on levothyroxine .075 mg for many years. I was diagnosed with high liver enzymes. I have been asking my doctor to switch my med to a natural med but they will not. I know that the med is hurting my liver but they deny it. Please, does anyone know of a great doctor in the Saginaw, Michigan area that will change my med before it is too late? Thanks for your help.

  14. Hadassah says:

    Janie , thank you so much . I just made an appointment with Dr Melnick I’m so very much looking forward to this appointment . I hope he can be of great help . You are very SPECIAL Janie you do a great service for the “THYROID SOCIETY” .

  15. Hadassah says:

    Janie , I’m on 88mcg of Synthroid and 24mcg T3 (Cytomel) so I’m wondering is that about right ratio ? And is it better to dose throw-out the day the T3 breaking it up three x a day or more ? And I do it sublingually . Thanks to you Janie .

    • Most patients on T3 multi-dose it since it has a short half life. We don’t look at ratios. We look at whether it’s putting our free T3 towards the top part of the range.

  16. Hadassah says:

    Janie , I am so very tempted to try NDT . Only because the way I feel . I was wondering three things . Being that I have sensitive stomach the preferred NDT would be Naturethroid or NP Thyroid ? With the least fillers . Also do you still need to add T3 (CYTOMEL) to the NDT ? And do you get the same benefits with swallowing as with sublingually ?

    • There’s really no preferred NDT. Some like Naturethroid; some like NP Thyroid; some like WP Thyroid. The latter two have the least fillers, too. A sensitive stomach can actually be the result of having low stomach acid, and NDT improves that. No, people do not add T3 to NDT. NDT is 20% T3 anyway. The only reason people add T3 to NDT is if they have either low cortisol and/or low iron. Yes about swallowing, though some report good results with sublingual.

  17. Hadassah says:

    Janie , is that with T3 adding to T4 (Synthroid)?

  18. Hadassah says:

    I was wondering that I have fatty liver after being on Synthroid only for 23 years . By adding T3 and not going on NDT help as well ?

  19. ChipL says:

    I was diagnosed hypothyroid at age 13, with anaemia, coeliac and diabetes. For 5 years I took Armour meds from Dr Walzack near LA. Then an endocrinologist in Boston put me on levothryroxine. I have taken 300mcgrams for 41 years, and I’m now 54. I have just had my first liver function test which showed dysfunction of some sort. Your website has me thinking I will ask to switch back to Armour meds.

  20. Tina says:

    My ND wants me to be tested for heavy metals. He believes this could be a culprit in my thyroid issues and why my body doesn’t convert t4 to t3. The method of removing the toxic metals is done through chelation through an iv. I also heard this can be hard on the liver, although the ND says he doesn’t know anything about that but it can be hard on the liver to have high levels of toxic metals. Does anyone know anything about this? I think I should have a liver function test.

    • Jeanne says:

      When you mentioned that your doctor pointed out your inability to convert T4 to T3, this got my attention. I have had the same problem for many years. I only just found out recently, after genetic testing, that my T4 conversion problem is mostly due to genes mutations that cause a reduced ability to convert T4 to T3. I am hoping that if I print out the gene reports, I can get my doctor to listen to me about taking T3 only, medicine. My pcp is stuck in 1970…. still refers to TSH as the only guide for thyroid function.

  21. Melania says:

    Ok, this just terrified me!

  22. melanie bridges says:

    I have had thyroid cancer and thyroid removed and have been told I have to take high doses of synthroid to keep cancer suppressed. They said other meds. Would not be effective

  23. claire hunter says:

    just found out i have elevated ALT levels so now scared that i may have liver issues now as well as thyroid and adrenal. if i do have it i hope that something can be done about it. i take levo/t3/hc cream/loads of vitamins, i literally dont know what im doing wrong. they have detected low phosphate too.

  24. jackie says:

    I have been on thyroid medication since I was 18 years old ranging from .25 to.200 mcg daily of synthroid or levythyroxine. I turn 46 in October and was just diagnosed with liver cancer last week. I don’t drink or smoke and do not have hepatitis.. I’m seriously freaked out and pissed off that this “medicine” every Dr demanded I continue taking has potentially poisoned me!
    Where do I even go from here?

    • Jackie, I don’t blame you for being pissed. I just know if it was me, I’d get off Synthroid and move over to Natural Desiccated Thyroid. But you’ll want to make sure you have good cortisol and iron. The liver needs T3. I’d also look into each and every thing I could find to treat liver cancer along with the allopathic methods. For example, this doctor states that low iodine levels could contribute to liver cancer: There’s a lot to read out there.

    • jack says:

      you need to report this to the FDA . Make some noise! there are others with liver problems listed in pubmed who can’t take synthroid due to elevated liver enzymes. feel badley for you so sorry

  25. Chris Norton says:

    I wanted to share a situation. My mom is now 70 and was diagnosed with fatty liver disease in 2002 and now cirrosis (sp)? She was on synthroid for many of those years in misery until switching to Armour last August. Her ammonia level is sky high as well and the doctors are totally baffled because they have no explanation for the liver issues. Could she be one of the stats referenced?

  26. Kaila says:

    Is there a big difference between armour and naturethroid? I’m switching my 10 year old daughter off of synthroid and I’m on armour.


  27. Sereena says:

    Well, since finding your website and reading your book, I searched for and found a doctor who prescribed natural thyroid extract. But within days of starting it, my liver started to ache. I thought perhaps it was because it was getting used to this new drug. As my grains went up, my liver pain did as well. I know its the natural thyroid extract, because I recently went on a two week holiday and unfortunately forgot my medication. Had no choice but to go without. And guess what? My liver pain stopped. So I have no doubt its from the extract. Will have to go back to my doctor when I can to find out why this is happening.

    (From Janie: natural thyroid does not directly cause the liver aches. Having other problems, that the natural thyroid reveals, could. Read and Become informed so you can teach your doctor!)

  28. Nicole S says:

    I am so grateful for this site. Being born without a thyroid and trying to find a doc that will get me off Synthroid has been a struggle. I have been on it for 30 years. I was just diagnoses with a fatty liver on Monday and I am scared. I also have Celiac. 🙁

    (From Janie: it’ll all work out. Celiac is well treated by going gluten-free, and there is a LOT out there now without gluten. 🙂 Fatty liver will also improve once you are on desiccated thyroid and raising high enough to remove symptoms. Here are patient groups to help: )

  29. Laura Caliguari says:

    Can you please tell me the exact title of the journal article in Hepatology? I’m looking at their website (May issue) and cannot find what you’re talking about. Thanks for all of your help, Janie. I really don’t know what I would have done without you and your website for guidance. I am currently treating myself (don’t ask!) with Armour/Isocort and have never felt better. I understand your parting of the ways with Armour, but please keep closely in touch with us on your blog about how you’re doing on your new meds. Love ya.
    Laura (from Janie: I’ll look and if I can find it, I’ll post it here. And yes, I’ll let you know how I’m doing on Naturethroid. Update: strangely, when I use the search engine, it won’t work)

  30. nikki says:

    I suppose taking the time to put 2 and 2 together and checking out helpful information would be very beneficial for many hypothyroid sufferers.

    There is proven information and fact that being left hypothyroid can cause liver issues. Weak livers can become damaged / inflammed and sick. If T4 thyroid meds keeps a patient under preforming optimally in thyroid health – the liver can be comsumed into poor quality and function.

    Throw in a shooty conversion table on T4 meds depending soley on using liver function to convert into T3 – and there it is.. a pooped out poisoned liver overloaded to no end….

  31. Janie says:

    Hi Mary. The article really has nothing to do with being on T4. It has to do with being “hypothyroid”.

    And I feel pretty safe saying that being on T4 leaves most with continuing hypothyroidism, and I also feel safe saying that being on desiccated thyroid (and in the presence of strong or well-treated adrenals) results in the removal of hypothyroidism symptoms.

    And as a result of the above paragraph, I can make a good “assumption” that the study mentioned only underscores how important it may be to our livers not to stay hypothyroid as being on T4 does, just as it has already shown to be important to our hearts, another major organ. 🙂

    Hope that helps.

  32. Lily says:

    Was I the one that you think disagress with you? I don’t disagree with you that dessicated thyroid is better. It is, by far. But this point on Liver Cancer would be stronger if we knew for sure that people in this study were on T4 medicaton. I don’t have access to the journal and can’t say for sure.

    I have always been on Armour and suggest it for any hypo patient, but when there is a chance to be specific on studies such as these, I prefer clarity if possible.

  33. Lily says:

    Were the people with Liver Cancer in the study on T4 only medication or did they have high TSH levels?

    Unless you can say that for sure, don’t assume that the addition of natural thyroid medication would reduce the elevated risk of liver cancer within this cohort.

    I am on your side, I just prefer that you not make unnecessary assumptions or imply a correlation where one doesn’t exist.

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