donate now The Fatty Liver Foundation

What if Resmetirom is approved but you can't get it?

With the possibility of Resmetirom being approved soon, as patients, we need to be aware that availability of the drug will still be limited and some months away even if approved.  Beyond that many of us will not be proper candidates for the drug as it likely will be approved for a specific patient population and the response of insurers is still an unknown.  So what might the Madrigal research teach us that could help patients who can't qualify for the treatment?

Resmetirom is a thyroid agonist that works in the liver to increase important thyroid hormones.  Thyroid is often diminished in patients with NAFLD/NASH.  This effect is known but many docs don't pay any attention to thyroid.  If you haven't had yours tested you might ask your doc to take a look at that issue.

Low thyroid is usually treated with Synthroid, a well known stimulator of thyroid.  While we may not be eligible for Resmetirom any time soon, managing low thyroid will probably be helpful for our livers. However, it is important to know that thyroid hormones will not cure your liver disease so don't try to cure NAFLD/NASH by taking lots of thyroid.

Don't assume that this is medical advice.  I am just looking at well-known functions which have some confirmation in the studies that Madrigal has done. Discuss this with your doctor.  The benefits of thyroid treatment for liver disease needs more research but we know that low thyroid is not healthy but is often overlooked in current practice.  Here is an overview of the hormone functions.

Thyroid hormones play a valuable role in the treatment of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) due to their effects on lipid metabolism and liver inflammation.

**Effects on lipid metabolism:**

* Thyroid hormones increase the activity of enzymes involved in fatty acid oxidation, leading to a decrease in hepatic lipid accumulation.
* They also promote the synthesis of apolipoprotein A-1, a protein that is essential for the formation of high-density lipoprotein (HDL), the "good" cholesterol.
* Additionally, thyroid hormones inhibit the synthesis of triglycerides, the main component of fat droplets in the liver.

**Effects on liver inflammation:**

* Thyroid hormones have anti-inflammatory properties and can reduce the production of pro-inflammatory cytokines in the liver.
* They also promote the regeneration of hepatocytes (liver cells) and can help to improve liver function.

**Clinical evidence:**

Several clinical studies have shown that thyroid hormone therapy can improve liver histology and reduce inflammation in patients with NAFLD/NASH. For example, a study published in the journal "Hepatology" found that treatment with thyroid hormone for 12 months led to a significant reduction in liver fat content and improvement in liver enzymes in patients with NASH.

**Potential benefits of thyroid hormone therapy in NAFLD/NASH:**

* Reduction of liver fat content
* Improvement of liver inflammation
* Prevention of fibrosis and cirrhosis
* Improved insulin sensitivity
* Reduced risk of cardiovascular disease

It is important to note that thyroid hormone therapy should only be used in patients with NAFLD/NASH who have hypothyroidism (underactive thyroid). Thyroid hormone therapy is not recommended for patients with normal thyroid function.

Overall, thyroid hormones have the potential to be a valuable treatment option for NAFLD/NASH, particularly in patients with hypothyroidism. Further research is needed to determine the optimal dosage and duration of thyroid hormone therapy for patients with NAFLD/NASH but a normal level is important to maintain so talk to your doc.