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Data supporting an association between primary hypothyroidism and non-alcoholic fatty liver disease (NAFLD) is lacking. Thyroid hormones are totally involved in the regulation of body weight, lipid metabolism, and insulin resistance. Therefore, thyroid hormones may have a role in the pathogenesis of NAFLD and nonalcoholic steatohepatitis (NASH). The results of studies investigating the association between NAFLD and thyroid dysfunction have been inconsistent; many have provided data supporting the association, while a few others have refuted it. This report presents the case of a 56-year-old obese Hispanic man who was diagnosed with liver cirrhosis secondary to NAFLD and presented 3 months later with severe hypothyroidism.