Liver, hyperthyroidism, carbimazole

[JuSa44]

I have been on 15mg of carbimazole for a month to treat my Graves relapse. I started on 30mg and felt worse than being hyper so my endo said I could take half. It has taken me about a month to feel slightly better. I am improving although my insomnia is still challenging.

I had a blood test this week and my TSH is still very low, my T3 is normal and my T4 is almost in normal range.

It concerns me that my liver function has become problematic. My ALAT (GPT) is higher than normal and other markers seem to be rising since I became hyper. The hyperthyroidism and carbimazole seem to be messing up my liver. Is this normal for people who take carbimazole or are hyperthyroid?

Can you recommend things I can do to help my liver? I’ve heard milk thistle and NAC are good.

Thanks so much. This community has helped me so much in the past month.

[PurpleNails Administrator]

Do you have FT4 & FT3 levels? Carbimazole dose should be adjusted by “frees” not TSH. It can take a long time for TSH to respond, don’t expect it to rise to reflect FT4 & FT3 quickly. I’ve been on carbimazole 5 years & it’s never risen & FT4 & FT3 have been low at times.

I have heard of carbimazole causing liver issues but it’s so rare doctors are instructed not to routinely monitor for issues. I’ve found some doctors just automatically order liver function & blood count.

I think doctors look at a set of liver results & how out of range they each marker are as a whole context. So 1 of the markers being slightly out isn’t concerning to them, but if several were very abnormal it would be.

I’d get your dr to explain if it is or isn’t an issue.

Being hyper can affect almost everything, I’m guessing your doctor may say it’s part of being hyper.

I can’t say for sure if milk thistle or NAC would improve it if there were an issue but it’s not likely to cause harm if taken in the levels recommended.

[JuSa44 in reply to PurpleNails]

This is interesting, thank you! On my blood test results, it just says T3 and T4 and doesn’t say anything about ‘free’. I will follow it up!

[Ellie-Louise in reply to JuSa44]

Look up Liverel.

I have a doctor very concerned about my risen liver enzymes, so I looked them up and did some research. I came across this and the reviews were extremely helpful. People said their liver enzymes had gone down, it had helped digestion etc.

Well it’s certainly helped with my digestive issues, I can hardly believe it. I won’t know about my liver until my blood test around July.

Edit: correction of spellcheck.

[JuSa44 in reply to Ellie-Louise]

This is interesting! I’m going to research it now. Thanks so much!

[pennyannie]

What about asking to switch to the alternative AT drug - Propylthiouracil - PTU - ?

[Embems1]

Hi JuSa44. I am in the exact same position as you-my ALT is high, out of range. I finally had my endo appt and he was unconcerned by the small increase, even wants me to increase my carb dose to 20mg 🤷‍♀️ (FT3 yet to come into range). My white blood cells are dropping too btw. I'm not sure that I've full confidence in him tbh...he tried to say my enzymes were high before, but this was in 2012, when I was pregnant! Also kept talking about my TSH 🙄.

I've decided not to worry until my next set of bloods which are, admittedly, soon at the beginning of May. Not decided what I'll do if they worsen- start the milk thistle? Maybe switch to PTU? The alternative is a bit drastic so I think as long as I can request monthly monitoring until (hopefully) things settle, then I'm happy with that.

Good luck to you!

[JuSa44 in reply to Embems1]

Thanks so much! It is reassuring to know this is sort of normal. The thyroid is so powerful and affects everything. I hope you get better soon!

[Embems1 in reply to JuSa44]

Thank you! Do let me know how you get on, and I'll do the same X