Test results today, elevated AST, ALT and TSH

[erin]

I went to get my 6 monthly routine thyroid and B12 test and mentioned to the dr about my swollen ankles. He added some more tests regarding kidney, liver and rhumatoids.

I have Hashimoto's and not prescribed any medicine until today.

T4 .956 ng/dl normal is .93 - 1.7 my value was 1.29 6 months ago

Tsh 7.53 uIU/ml normal is .27 - 4.2 it was 3.75 6 months ago

now I am prescribed Euthrox 50 mcg now. I was told to start taking this first thing in the morning.

The urea and creatin is normal so is CRP and RF but

AST is 37 U/L normal is 0 -31 and this was tested in 2014 was 24

ALT is 47 U/L normal is 0 -34 and this was tested in 2014 was 20

Not only I am dissapointed with a high increase on Tsh and have to take a fake hormone, I am worried about my liver values.

Should I worry about them? Anyone knows about AST and ALT and care to answer?

 

[Cheesus]

Most hepatologists wouldn't batter an eyelid at those liver results. The reference range for my local lab is 0-40 for both AST and ALT. People with serious liver disease can have AST and ALT well into the hundreds, and i read a case study of a woman who had an ALT of nearly 1000 (though she very nearly died).

I wouldn't worry about it. It could easily be a supplement or perhaps simply nothing at all. Your liver enzymes could remain at that level indefinitely and you would never suffer from any kind of liver disease as a result.

Follow the advice of your doctor. It is possible he or she may want to retest in 3 to 6 months, but i doubt it would show anything meaningful.

 

[erin]

@Cheesus thank you very much for the reply, very helpful. I feel relieved.

 

[Cheesus]

@Cheesus thank you very much for the reply, very helpful. I feel relieved.

I am pleased to hear it. Fluctuations in liver enzymes are quite normal and can be caused by a million things. This slight elevation could even be connected to your ME. As I say, it wouldn't hurt you to check it again in 6 months or so to be on the safe side, but I doubt anything would come of it. Just follow your doctor's advice.

 

[erin]

I will definitely to get it checked in about 6 months time. My doctor was more concerned about the Tsh. I guess I just have to start taking the thyroxine hormone now. Thank you again Cheesus.

 

[Loachi]

I will definitely to get it checked in about 6 months time. My doctor was more concerned about the Tsh. I guess I just have to start taking the thyroxine hormone now. Thank you again Cheesus.

Thyroxine is a med you need indeed to take first thing in morning, best some time before breakfast.
But, even if 50mg is not a huge dose, Thyroxine is one of those meds who need to be adjusted now and then until you find the right dose who works best for you. They usually do not wait as long as 6 month to do a first evaluation, but one doc is not the other.

 

[erin]

@Loachi thanks for your insight. I called my gp and mentioned what happened at the hospital. She wants to repeat the test and other tests, actually a full check up. I gave blood the day before yesterday. Tomorrow results will be discussed.

 

[erin]

Got my repeat test results yesterday. Tsh and fT3 and 4 are the same values. I started euthyrox today. I don't feel any effect of this medicine yet.
However, ALT and AST was different in the second test. They were in the normal range. I was pleased to this but this second test is a complete check up and other liver values appear elevated.

Cholesterol is 246 mg/dL where normal is 200
HDL is 72 and I think it is ok
LDL 153 mg/dL where normal is <130
GGT 53 U/L where normal is between 9-36

The test is very long and I couldn't access it online. I would've like to insert it here but I can't. Quite a lot of the measurements were borderline but within the limit.

GP said cholesterol etc are high because of thyroid issues anhe didn't suggest ant diet etc.

Before I took this second test my B12 was 367. This was after taking sublingual spray 3-4 times a week and an cyanocobolamin injection 2 months ago. I had another cynocobalamin injection 2 days after this reading and gave blood for the second test. And in the second test B12 level was 547. I thought that it should've been higher.

 

[Kati]

Hi @erin, thyroid is a value that needs to be checked about 6 weeks or more to see if therapy is effective. Also, you are not likely to feel much difference from one day of thyroid medication.

Many things can increase your liver enzymes. For instance a viral illness, or a gallbladder stone blocking the duct temporarily. In my case recently my liver enzymes were elevated after antibiotic therapy for an infection. I could tell it upset my liver and the labs confirmed that. But that was temporary, thankfully.

Your liver enzymes are not extremely high and it sounds like your physician is not too worried. You should return to your Physician should you experience pain in your mid section, and certainly should you become jaundiced ( but this is not likely to happen).

My cholesterol and lipid profile is also out of whack, without my dr 'giving me a diet'. Doctors usually don't 'give patients a diet', at least it's not like it here.

I suspect that lipid profiles are dysregulated due to ME, as seen in the Naviaux paper. But I may be wrong on that.

 

[erin]

Thanks Kati.
My GP said she will repeat the thyroid test 6 weeks later. She thinks an adjustment of the medication might be necessary after 6 weeks. I thought this was quite soon too. She said I am starting with a small dose, I probably will need more. I take BBlockers and have tachycardia, I was worried if the thyroxine hormone will have a bad effect on this issue. But it seems to be OK so far. Will see what will happen in the early hour of the morning, usually I have the tachycardia.
I haven't used any antibiotics for years. I do have some pain and bloatedness every now and then. Actually maybe more often. There are times I don't have the neither pain nor the bloating. I don't have jaundice. I'm hoping I don't have any liver disease or pancreatic illness or gall bladder problems. There is some discomfort I experience at times.

 

[Kati]

Thanks Kati.
My GP said she will repeat the thyroid test 6 weeks later. She thinks an adjustment of the medication might be necessary after 6 weeks. I thought this was quite soon too. She said I am starting with a small dose, I probably will need more. I take BBlockers and have tachycardia, I was worried if the thyroxine hormone will have a bad effect on this issue. But it seems to be OK so far. Will see what will happen in the early hour of the morning, usually I have the tachycardia.
I haven't used any antibiotics for years. I do have some pain and bloatedness every now and then. Actually maybe more often. There are times I don't have the neither pain nor the bloating. I don't have jaundice. I'm hoping I don't have any liver disease or pancreatic illness or gall bladder problems. There is some discomfort I experience at times.

Hi Erin, the bloating and pain you feel may well be related to your gallbladder. It is fairly common with our patient population. Do let your gp know if this persists, he/she can do an abdominal ultrasound to see where things are at. My disease onset was an EBV infection and I had liver involvement at that time, enough to require pain pills. My liver enzymes were high, and I had a liver ultrasound which showed sludge in the gallbladder, but no stones. i had a few more gallbladder attacks until the mother of all gallbladder attacks which sent me to the hospital for 10 days, it was necrotic.

Gallbladder related pain usually comes late at night.

Sending best wishes.

 

[erin]

Kati your gall bladder experience is terrible. You must be brave to gone through such an ordeal.
I feel my pain is usually in the morning after breakfast. We'll see what happens. I feel not to bad today. I have energy somehow. I feel like a kid who has given a full bag of sweeties and I want to do all the things I normally don't have the energy to do. I somehow can't stop myself and worried about crushing at the same time.

 

[Crux]

Hi @erin ,

I see you're having many tests and much on your mind, but here's another thing to consider if it's not hypothyroidism alone.

Elevated GGT isn't specific, but it does show that there's inflammation.

Having liver pain is an important symptom.

Have you ever had an iron panel done? It would include serum iron and ferritin; but most importantly, transferrin saturation - TS,TIBC, and UIBC.

Iron deposition in the liver can cause pain, elevated enzymes, elevated GGT, and more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620378/

edit : I just realized that the article initially implies alcohol abuse as a cause of elevated GGT.
Please disregard this. People with liver conditions are often accused of alcoholism, when it is Not true.

 

[Kati]

Kati your gall bladder experience is terrible. You must be brave to gone through such an ordeal.
I feel my pain is usually in the morning after breakfast. We'll see what happens. I feel not to bad today. I have energy somehow. I feel like a kid who has given a full bag of sweeties and I want to do all the things I normally don't have the energy to do. I somehow can't stop myself and worried about crushing at the same time.

Hi @erin it was not my intention to scare you, I just wanted to share that gallbladder problems is common and that sometimes you get minor elevation of liver enzymes with that, but then it settles down for a while. Being aware helps preventing complications.

 

[erin]

Thanks @Kati, I am not scared at the moment. I will wait and see.
@Crux I was writing the rest of the test results, iron panel etc. but some how I lost what I wrote.

 

[Kati]

Thanks @Kati, I am not scared at the moment. I will wait and see.

Probably the best thing to do.

 

[erin]

@Crux this was the iron panel results

Iron 79 ug/dL normal 50 -170
TS 290 ug/dL normal 120 - 420
TIBC 369 ug/dL normal 220 - 450
ferritin 17.33 ng/mL normal 4.63 - 204

Very detailed long test but unfortunately I can't get it online that I could paste it here. I was trying to type most of it but I've lost it somehow.
Apart from biochemistry, hormone and full hematological tests were carried out. All came within normal range, some almost approaching the borders.
Cholesterol, LDL, GGT and Tsh were the only elevated ones.
All other billuribines, glucose, globulin, albumin, LDH, ALT, AST, creatinine, uric acid BUN, potassium, calcium, sodium, vitB12 and D etc came normal.

 

[Crux]

Well, the results are normal x 4. Glad you can scratch that.

I hope the thyroid meds. resolve the remaining symptoms!

 

[CFS_for_19_years]

Iron 79 ug/dL normal 50 -170
TS 290 ug/dL normal 120 - 420
TIBC 369 ug/dL normal 220 - 450
ferritin 17.33 ng/mL normal 4.63 - 204

Your ferritin level isn't optimal. Ferritin needs to be higher so that T4 can convert to T3 (T3 being the active form of thyroid hormone). If your ferritin is not high enough you won't be able to convert T4 to T3.

http://www.stopthethyroidmadness.com/lab-values/

FERRITIN: Measures your levels of storage iron, which can be chronically low in hypothyroid patients but along with low iron/low % saturation. If your Ferritin result is less than 50, your levels are too low and can be causing problems, we’ve noted…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are lower than the 50’s, you are scooting by. Optimally, females shoot for 70-90 at the minimum. [.....]

SERUM IRON (also called just Iron or Total iron): Measures the small amount of your circulating iron which is bound by the transferrin. You are looking for ‘close to’ 110 for women, upper 130’s for men, based on what we’ve seen on hundreds of lab results.[......]

TIBC (Total iron binding capacity): measures whether a protein called transferrin, produced by the liver, is enough to carry iron in the blood. Used to determine anemia or low body iron. If your result is high in the range and in the absence of chronic disease, you may be anemic. With healthy amounts of iron, this test will be low in the range—about 1/4th above the bottom number in the range provided.

Btw, it's possible to have low iron stores without being anemic.

If you're looking for a good iron supplement that won't cause stomach upset or constipation, I've had good luck with Floradix iron (liquid or tablet). I've seen my ferritin go up from taking it.

ETA:
http://www.tpauk.com/main/article/low-serum-ferritinhypothyroid-connection/

WARNING FOR THOSE ON THYROID HORMONE REPLACEMENT AND TAKING IRON
Be careful when adding iron to your diet if you are hypothyroid, because taking iron within four hours of taking your thyroid hormone may interfere with the absorption of your thyroid hormone and make it less effective. [.......]

Biologically, insufficient iron levels may be affecting the first two of three steps of thyroid hormone synthesis by reducing the activity of the enzyme thyroid peroxidase, which is dependent on iron. Iron deficiency, in turn, may also alter thyroid metabolism and reduce the conversion of the inactive T4 to the active T3, besides modifying the binding of T3. Additionally, low iron levels can increase circulating concentrations of Thyroid Stimulating Hormone (TSH).[....]

The normal range for ferritin is usually between 30 and 300 mg/dL in men, but it is recommended that for everyone with a ferritin less than 60 mg/dL, they should be given iron treatment. The goal of treatment is to raise ferritin levels to a value between 70 and 90 mg/dL and this is usually achieved with oral iron treatment. Raising ferritin levels to this range may be needed for patients with hypothyroidism to have an optimal response to thyroid hormone treatment.

 

[erin]

Thank you for the detailed information. I will try to find a good iron supplement.

I started to use Euthyrox 50 mcg, it is giving me headache since two days. I don't quite feel myself. I have all sorts of pain but I don't get headaches much normally. I am getting worried about this.