I had a total thyroidectomy following it being enlarged and covered in cysts in August 2018 - blood tests also showed my thyroid levels were falling out of range. This followed a partial thyroidectomy for the same reason in 1994.
10 months after the 2018 surgery, so by mid 2019, my thyroid levels balanced out at the required levels (taking 100 of levothyroxine). All other blood test results were fine including liver function.
Unfortunately then my gallbladder started playing up. I have heard there is a link between thyroid and gallbladder. I had loads of gallstones that were causing pain and distention so I had my gallbladder removed in March 2020 and my LFT was absolutely fine then - and it was checked repeatedly then.
Fast forward to the beginning of this year, and I had a blood test for iron levels (they are often low, I take a supplement, they go back up, then the cycle restarts) and had a routine LFT added to the form. This showed raised liver enzymes (I don't know which ones). Then at my annual thyroid blood test in June I had a LFT added again to see if it had gone back down. The results showed my thyroid levels were fine but my liver enzymes were still slightly raised.
So I had the LFT and thyroid done again last week and this shows my liver enzymes have increased from last time and my thyroid hormones are "just about balanced" whatever that means.
I should add that I gave up on alcohol altogether about 5 months ago and I can count the number of times I've drunk alcohol this year on one hand, cut out sugary food (except energy gels for long weekend runs in the build up to the London marathon which I ran a few weeks ago - blood test was about 11 days after the marathon). I eat exceptionally well - home cooked foods, lots of wholegrains, about 10 of my 5 a day, I exercise 5 days a week (running and swimming) and I feel very well in myself. I also have polycystic ovary syndrome which is managed with metformin (non-diabetic).
I'm really perplexed as to what's going on and why my liver is getting worse as I get healthier. Or why my thyroid levels now sound suspiciously less than as ideal as they were only a few months ago. I know I need to speak to my GP but goodness knows when I'll get an appointment, the receptionist was a bit shirty and said ring back at 8.30am some time but the doctor hasn't asked for an appointment with you, only for you to repeat the tests again in 6 months and to have the blood test before I take my thyroid medication. Why is that?
Any thoughts?
Final comment - I do have health anxiety, I realise this. It started after my mum was diagnosed with the "it won't be that, it's very very rare" terminal brain tumour in 2015 and we lost her 18 months later. I don't feel safe from "it's rare" anymore.
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If you have run a marathon on only 100mcg levothyroxine daily….you likely need dose increase
How much do you weigh in kilo approx
What vitamin supplements are you currently taking
Do you always get same brand levothyroxine at each prescription
What are your most recent thyroid and vitamin results and ranges
“I had a total thyroidectomy following it being enlarged and covered in cysts in August 2018 - blood tests also showed my thyroid levels were falling out of range. .”
Presumably this was Hashimoto’s
Low vitamin levels are extremely common, especially with/after autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Low vitamin levels common as we get older too
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
How much do you weigh in kilo approx - not much, about 55kg
What vitamin supplements are you currently taking - low dose iron with Vitamin C, magnesium, I was taking high strength cod liver oil in the marathon run-up
I asked for a B12 test about a year ago and it was normal.
Do you always get same brand levothyroxine at each prescription - no, sometimes it's different... didn't realise it would cause any problems if the dose was the same!
What are your most recent thyroid and vitamin results and ranges - reception and doctor will never say, they seem to have a policy of not giving numbers out to stop Dr Googling (which I do anyway). Ferritin was tested and was 'normal' but I've been buying my own higher strength iron tablets over the counter since the GP stopped them once iron levels were normal as I knew they would drop in marathon training (I realise I shouldn't do this!). I've stopped taking them again now the marathon is done.
Hashitomos - never been diagnosed with this, I've heard of it but assumed I didn't have it as it was never mentioned... will go and read up on it!
Could the thyroid be causing the liver problems? Or vice versa?
What are your most recent thyroid and vitamin results and ranges - reception and doctor will never say, they seem to have a policy of not giving numbers out to stop Dr Googling (which I do anyway).
Note that you are legally entitled to have access to your medical records and test results either online or, if this is not possible, then on paper, however not all surgeries are geared up for online access. Theoretically you should be able to just ask for this access or paper copies, but some surgeries are still obstructive despite the fact this legal entitlement has existed for years. They may ask you to fill in a form, which is usually okay, but if they are still obstructive you could make an official "Subject Access Request". These are easier to do than it sounds and it is described on the Information Commissioner's Office website :
When you ask for copies or access to your own data note that you don't need an appointment to see the doctor (and asking for one for this purpose will just annoy your doctor), you should be able to just ask the receptionists. You ought to be asked to supply proof of identity.
Don't accept verbal test results or hand written ones - there is far too much risk of information being missing or wrongly written down. You need them to come out of your medical records on computer.
Also staff aren't allowed to ask why you want the data from your records, but they very often do. Just say you want it "for my own records".
I had a liver function test done a few years ago, and one of the results, alanine aminotransferase (ALT) , came back over the range. I did some research and discovered that ALT can be raised by too high an intake of carbs and sugar. I changed my diet to one containing more protein and fat and lower levels of carbs and sugar. Eight months later I retested and my ALT had dropped to be about mid-range.
The simplest and most likely explanation (but not necessarily the correct one) for a raised ALT is high levels of fat in the liver. And despite what most people think a fatty liver develops with a diet which is too high in carbs and sugar, it has nothing to do with fat.
I eat exceptionally well - home cooked foods, lots of wholegrains, about 10 of my 5 a day,
I don't know what your "10 of my 5 a day" means, but if it contains fruit then fructose from fruit is one of the most unhealthy "natural" sugars there is. Whatever you call it, it is still sugar.
Your energy gels are also probably not good for you. I don't know much about them but they supply lots of glucose. I have read about people who have switched to a low carb, higher protein and higher fat diet and have run marathons while avoiding carbs altogether and have done well.
One resource that has loads of info you might find useful is this website - look up the general info and also the info specific to insulin resistance and type 2 diabetes :
Another reference I like is the Diet Doctor website. It isn't just geared up to helping people lose weight, it is all about healthy eating too. And anyone who doesn't need to lose weight can just increase the portion sizes of their recipes (which are all gluten-free).
Another source of info on insulin resistance is Prof Tim Noakes. He has written (amongst many other things) a series of 11 articles on the subject starting with this one :
I've ditched the energy gels now - I've run my marathon, I don't think marathon running is healthy, so I will only be doing it the once!! 😄 I did however suspect that the gels were a very bad idea and will be giving the ones I have left away to a good home.
My 10 a day is mostly veg although I do have grapefruit and blueberries for breakfast. I think my diet is pretty sound, using lots of information I learnt after my PCOS diagnosis 15 years ago, but I had lapsed into the odd treat which I stopped many months ago now.
I will have a good read of your links this evening. My husband and children all have covid so I'm living a solitary life avoiding them all, and therefore I have plenty of time!
If this is any help, prior to long overdue treatment for hypothyroidism, I had raised liver enzymes, alt, g.p. blamed alcohol but after a few months levo treatment they returned to normal. Strong connection between liver and thyroid.
I’m not sure this helps, but when I was in Romania buying levo, the pharmacist asked if I wanted some liver protection supplements. I asked why I would need this and they said that levo (like any other pill) can have a bad effect on the liver. I didn’t get any liver protection supplements but I’m thinking about it. The doctors in UK never mentioned anything about the liver and they never said to do liver related blood tests.
They didn’t say and I didn’t ask because I didn’t really believe I needed any. As I mentioned, the doctors in UK never mentioned any possible issues with the liver while taking levo. As for the pharmacist, I can’t speak for their intention but it is possible for them to want to sell more stuff.
I’ll ask the endocrinologist next time I’ll see him next month. But I do think the doctors and pharmacists in Romania have a different approach from the ones in UK - they tend to give people more medicine. Also, I grew up with the impression that pills affect the liver, especially taken a long period of time (I don’t know how my parents came to this idea).
I was guilted by Occupational Health at my work after a health check, which included wide range of blood tests, but not thyroid, and then my GP, implying I underestimated my alcohol intake due to raised liver enzymes. Eventually I was diagnosed with Hashimotos , and my liver enzymes have come back down to acceptable levels, despite still being under medicated. After several years of anxiety and imposed almost tee-total I can now enjoy the odd glass of wine! Background literature research shows clear link between hypothyroidism and raised liver enzymes. Incidentally my dietician wife has convinced me of the health benefits of a low carb / low sugar diet which has resulted in a steady weight loss (without any dieting) which helps my knee arthritis and no doubt everything else!
My endocrinologist always tests liver and cholesterol levels along with usual thyroid tests. My liver tests were above range along with cholesterol and only went down when I was on a high enough dose of levothyroxine and added some t3 as well. I would see whether you need to see about a dose increase as it’s clearly not your alcohol consumption and I don’t think you should have to eat like a saint just to have you liver tests in range.
I've managed to speak to my GP about my tests (a miracle in itself). She said that my thyroid levels show that the TSH is perfect but overall and I forget what element she said but something it's at the top end of normal but this is probably because I had the tablet before the blood test.
She said my liver ALT should be <35 and over the last 3 blood tests has gone from 41 to 45 to 58. But she said it wasn't even double what it should be at the moment and she wouldn't worry until it was three times over, but attention should be paid to the increase - particularly given that I lead a very healthy lifestyle.
She said possible reasons for this are 1) PCOS, 2)the metformin I take for the PCOS, 3) perimenopause hormones, 4) hemangiomas (I have 3, spotted on a scan in 2020 when my gallbladder went wonky), 5) a rise following the removal of my gallbladder meaning my liver is getting backed up with bile more now, or 6) that there is a gallstone left in the duct.
The next step is a liver ultrasound to see if there's anything obviously amiss, which may be followed by more liver tests including AST. That should be in ~6 weeks.
Thank you. I’ve found this thread interesting to read because I gave Hashimoto’s (25+ years) and my liver enzymes have always been within normal range. But my last blood results showed a raised ALP. All other liver results were good? So…I’m not sure why. I will be doing a repeat blood test. Be good to hear how you get on 👍
I think the repeat test often shows that the level went back to normal, so hopefully that wil be the case for you. It was what I was expecting to happen to me as I'm the healthiest I've ever been, but sadly mine are going the other way.
I was interested to read your post as I have a similar situation. My thyroid is they say borderline hypo (I think it's hypo with TSH at 5.5...but they say no it has to be at 10 for consecutive tests. T3 and T4 low end of scale. No hashimotos.) Tsh has been raised for 24 months. My cholesterol has gone up and I recently got a cyst on my liver and now have non alcoholic fatty liver. I don't eat dairy, no red meat, lots of cruciferous veg..walk at least 5 km every day , spinning class, online workouts X2/3 per week. I paid a consultant £200 to be told I need to just lose weight. I weigh 12 stone. I'm struggling to figure out what I can actually do! Any suggestions welcome.
Sorry to hear you are having similar struggles. Like you I eat really healthily, I run x3 a week, swimming x2, strength train, yoga, do the school run on foot, don't drink/smoke, I'm a model bloomin' citizen!
I only weigh about 8 stone, so I have nowhere to go weight wise! I said to the GP earlier "There is nothing further I can change to improve it" and she didn't disagree. So I don't know what to suggest to you, as I don't know myself!
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Elevated liver enzymes 
Cytomel and Liver Pain/Elevated Liver Enzymes
Raised liver and kidney function 
highest liver - don’t know why think it’s thyroid 
