Elevated FT3 and liver enzymes on NDT

[Cayenne44]

Hi all-

I posted here about 3 months ago with a long story and I've been keeping up with everyone's helpful advice on this forum. I've been back to the doctor to get blood tests since I last posted. My recent tests show a really high FT3 with other thyroid results normal. And for some reason my liver enzymes are elevated. I did the test in the morning, while fasting, with my last dosage 24 hours prior. I have a couple questions:

1. Does a really high FT3 mean I'm over medicated? My doctor doesn't think so and has kept me on 4 NDTs a day. I feel great and I don't have any hyper symptoms at all.

2. Are out of range liver enzymes normal with elevated FT3? My doctor also thinks this is fine, but I'm concerned this could damage my liver. I had a full blood panel about a year ago prior to any thyroid meds and my ALT and AST were fine.

I'm thinking of dropping down to 3 or 3.5 pills a day to try to bring everything in range. I've read that your liver processes and filters T3 and T4 so I'm wondering what the direct correlation with liver enzymes and NDT are. Here are my last test results:

TSH .01 .4 - 4.50

FT3 5.8 2.3 - 4.2 high

T3, total 182 76 - 181

FT4 1.6 .8 - 1.8

T4, total 8.1 5.1 - 11.9

both antibodies tests <1

Specific liver tests:

Albumin 4.2 3.6 - 5.1

Alkaline Phos 64 33 - 115

Biliburin, total .5 .2 - 1.2

ALT 69 6 - 29 abnormal

AST 35 10 - 30 abnormal

Other tests:

MCHC 31.7 32 - 36 slightly under

Ferritin 112 10 - 154

Iron, total 137 40 - 190

Iron Bind. Cap. 300 250 - 450

B12 537 200 - 1100 (B12 shots 1x month)

Vit D, 25-OH, total 55 30 - 100

Thank you all for the help! This forum is the best!

[greygoose]

Well, your over-range FT3 does mean you're over-medicated, I'm afraid - unless you have hormone resistance at a cellular level. And, you can only tell that by symptoms, really. But, if you're going to reduce your dose, it's best to do is slowly - 1/4 grain ever two weeks.

I don't know about the liver enzymes, I'm afraid.

[Cayenne44 in reply to greygoose]

Thanks greygoose- I'm thinking the best thing might be to reduce little bit by little bit to see how low I can go on the dosage before I become hypo again. It's just weird that I have no hyper symptoms but I guess everyone is different.

[greygoose in reply to Cayenne44]

You'll only have hyper symptoms if you're absorbing it all. If you have an absorption problem and the hormone isn't getting into the cells, the you won't have hyper symptoms. Just having high levels of T3 in the blood won't cause symptoms.

[Cayenne44 in reply to greygoose]

Thanks for the explanation! Sounds like I should go down a bit then.

[greygoose in reply to Cayenne44]

Well, that's not what I said, but never mind.

[trelemorele]

I've head elevated ALP on levothyroxine.

There are few articles on t4 toxicity and liver damage due to t4 (in some people, not all) on the net.

Have a look at this one. You may be in the same position and t3 could be your best option.

jstage.jst.go.jp/article/en...

[Cayenne44 in reply to trelemorele]

Thanks, that's really helpful! Maybe switching from NDT to T3 might be a better option, but I don't think that's offered much in the states compared to levo or NDT.

Was your doctor or endo OK with your elevated ALT? Did you continue on the same levo dose?

[trelemorele in reply to Cayenne44]

Doctors in general have very poor understanding of thyroid in the UK.

They have minimum to none understanding of people having conversion issues. And with regard to to t4 toxicity on liver I haven't met any doctor having slightest incline.

So, no my GP hasn't shown any interest in my liver tests being out of order.

I self medicate, I stopped taking t4 all together last November. It was my own decisions, no doctor was informed or involved.

[Cayenne44 in reply to trelemorele]

Same as the states- thank you for sharing!

[kferrer in reply to Cayenne44]

Are you in the US?

[Cayenne44 in reply to kferrer]

Hey kferrer! I am in the US

[silverfox7]

For future reference results are read differently when on any form of T3. TSH will be suppressed, FT4 can fall lower in the range and FT3 should be at the higher end of the range but never over.

[sirmot]

I had elevated liver enzymes when I was on a higher dose of T4/T3 combination therapy. They were reduced to normal levels after I reduced both levothyroxine and liothyronine. I don't know whether it was the T4 or T3 or both that had raised the liver enzymes. My T4 and T3 were within normal levels throughout, but higher in the normal range originally.

[Cayenne44 in reply to sirmot]

Thank you sirmot- sounds like if I lower my NDT, my liver enzymes will go down as well.

[Hidden]

When I was taking 3 grains of NDT last year my FT3 was 1/3rd over the top of the range.

I did have symptoms fast heart when resting and I was losing too much weight.

You have a high reading so maybe reduce by 1/2 half and then another 1/2 half then have another blood test in 6 weeks time. I am sorry i cannot answer your liver question.

Maybe take milk thistle which helps the liver.

[Cayenne44 in reply to Hidden]

Thank you bunnyjean! I think I'm going to reduce a half or quarter slowly- I don't have the symptoms like you did, but I think the 4 grains that I'm on is likely too high. Worth the experiment at least. I'll look into the milk thistle too!

[Hidden]

I have just reread you post and you left of NDT for 24 hours prior to the test instead of 12 hours prior, this maybe also gives a false reading.

[Stourie]

I think that if you feel good and your doctor is happy then leave well alone. Before blood tests doctors dosed patients until they felt well. Most peoples t3 would probably have been over the range if there had been one. Just my opinion. Jo xx

[Cayenne44 in reply to Stourie]

Thanks Jo! I've read a lot of the same advice on this forum.

[kferrer in reply to Stourie]

I just want to chime in and add that if you're not having symptoms and feeling basically well, why mess with that? The ranges can only be rough guidelines, sometimes, very, very rough guidelines.

[Cayenne44]

I'm in the states and the range for most of my recent FT3 tests is 2.3-4.2 pg/mL. I guess since I left 24 hours instead of the 12, my FT3 would be even higher than it already is. Thank you Grincho!

[jls1409]

When I was first diagnosed hypo last year, my liver enzymes were elevated. My doctor ordered an abdominal ultrasound. I had gall stones and one was starting to block the entry to the liver. I had my gallbladder removed and my enzymes were completely normal right away. I've been told that many thyroid patients have gall bladder trouble. Just my experience. Hope it's helpful.

[Fixture]

Hi, from US also. Docs don't seem to understand thyroid. Read the

[Fixture]

Sorry, I touched the wrong key! Anyway, any #'s out of range and you get the same script. My TSH is slightly elevated, but all other numbers in range. Also no real symptoms as such. The synthoid gave me tremors, the Armour thyroid gave me mouth sore and blisters. So I wanted to try LDN. No doc would give it to me, so I looked for one and was successful. My goal was to reduce the tremors and also the TSH. To date I am on 1mg/day. Will be getting blood test in Nov. want to thank the posts on the liver enzyme notes as I will ask for that also. Thriving is a constant battle in this wasteland of medical info.