Thyroid hormone receptors (TRs) are ligand-dependent transcription factors that mediate most of the effects elicited by the thyroid hormone, 3,5,3 0 -L-triiodothyronine (T3). TRs have been implicated in tumorigenesis, although it is unclear whether they act as oncogenes or tumor suppressors, and at which stage of tumorigenesis their dysregulation occurs. Using the resistant-hepatocyte rat model (R-H model), we found downregulation of TRb1 and TRa1 and their target genes in early preneoplastic lesions and hepatocellular carcinoma (HCCs), suggesting that a hypothyroid status favors the onset and progression of preneoplastic lesions to HCC. Notably, TRb1 and, to a lesser extent, TRa1 down-regulation was observed only in preneoplastic lesions positive for the progenitor cell marker, cytokeratin-19 (Krt-19) and characterized by a higher proliferative activity, compared to the Krt-19 negative ones. TRb1 down-regulation was observed also in the vast majority of the analyzed human HCCs, compared to the matched peritumorous liver or to normal liver. Hyperthyroidism induced by T3 treatment caused up-regulation of TRb1 and of its target genes in 1 preneoplastic rat lesions and was associated with nodule regression. In HCC, TRb1 down-regulation was not the result of hypermethylation of its promoter, but was associated with an increased expression of TRb1-targeting microRNAs ([miR]-27a, -181a, and -204). An inverse correlation between TRb1 and miR-181a was also found in human cirrhotic peritumoral tissue, compared to normal liver. Conclusion: Down-regulation of TRs, especially TRb1, is an early and relevant event in liver cancer development and is species and etiology independent. The results also suggest that a hypothyroid status of preneoplastic lesions may contribute to their progression to HCC and that the reversion of this condition may represent a possible therapeutic goal to interfere with the development of this tumor. (HEPATOLOGY 2015;61:249-259) T he thyroid hormones, 3,5,3 0 -triiodo-L-thyronine (T3) and thyroxine (T4), influence a variety of physiological processes.1,2 Most of the effects of T3 are mediated by thyroid hormone nuclear receptors (TRs), which are members of the steroid/thyroid receptor superfamily of nuclear hormone receptors, acting as transcription factors.