Objective: To review the epidemiological and pathophysiological associations between hypothyroidism and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), alongside evaluating novel thyromimetic therapies. 

Methods: A concise narrative review of the literature regarding systemic thyroid function, MASLD severity, and liver-directed thyroid hormone receptor-beta (THR-beta) agonists. 

Results: Epidemiological data show a significantly higher prevalence of MASLD in populations with both overt and subclinical hypothyroidism, a risk heavily compounded by concurrent metabolic syndrome. Mechanistically, thyroid hormones orchestrate hepatic lipid homeostasis; their localized functional deficiency within the liver (“hepatic hypothyroidism”) actively drives steatogenesis and fibrogenesis. Liver-directed THR-beta agonists demonstrate breakthrough efficacy in resolving metabolic steatohepatitis (MASH) and improving fibrosis. 

Conclusion: The bidirectional thyroid-liver axis operates as a pivotal driver of MASLD pathogenesis. Correcting states of hepatic hypothyroidism through targeted THR-beta agonism represents a clinically validated, disease-modifying therapeutic strategy.