Liver Enzymes

[Bridkid67]

Hi posted before currently on 75 mcg of levothyroxine I had a routine blood test 14th of January got a msg saying do a repeat one as one of my liver enzymes was slightly elevated they said nothing to worry about had another today and at teatime got a phone call from a Drs Assistant not a Dr and she said my Dr has referred me to a hepatologist as a liver enzymes was out of range asked why etc but obviously she is not a a Dr but said he hasn't put it as a urgent referral as you can imagine iam thinking allsorts etc going to Phone my Dr tomorrow for a more detailed chat just wondering has anyone else experienced this thanks .

[helvella Administrator]

Bridkid67,

The link below provides some information about liver blood tests and what they mean. I know that it is not uncommon for one or more to be raised in hypothyroidism. And quite often they simply resolve.

It is probably good that they have referred you - so long as the time to appointment is bearable.

If you are waiting for a long time, maybe your GP would repeat the tests to see if the issue has resolved, stayed the same or (hopefully not) worsened.

Liver Blood Tests

Also Known As Liver Function Tests, LFTs, Liver panel, Hepatic function tests

Formal Name

Hepatic Function Panel

labtestsonline.org.uk/tests...

[Bridkid67 in reply to helvella]

Thanks for that

[grumpyold]

Yes, I've experienced this too.

GP referred me to gastroenterologist. She said I should have a liver biopsy. I refused as they are invasive and I read scary reports of when they take chunks from wrong area of liver.

They then offered me a Fibroscan. Completely non invasive and much quicker to carry out (so, actually cheaper for the NHS!)

I was told I had fatty liver (NAFLD). At the time I was undermedicated and this was before I began sourcing my own T3.

Subsequent Fibroscans a year apart each time, have shown that my fatty liver improved and I no longer have NAFLD.

I'm sure that being left undermedicated contributed to causing it in the first place. Now resolved with my own T3 in combo with levo the NHS provides.

[helvella Administrator in reply to grumpyold]

They have renamed it!

MASLD, NAFLD and fatty liver disease

MASLD, NAFLD and fatty liver disease are different names for the same condition.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a long-lasting liver condition caused by having too much fat in the liver. It is closely linked with being overweight as well as conditions such as type 2 diabetes and heart and circulatory disease.

Metabolic dysfunction-associated steatohepatitis (MASH, previously called NASH) is a more serious stage of MASLD. In a small number of people it can lead to liver cancer or liver failure.

britishlivertrust.org.uk/in...

Not meant as criticism, but to help anyone reading this thread so they know both names.

[humanbean]

I've had three results over the years where my ALT was above range. They weren't consecutive. I discovered by experimenting that reducing my sugar intake e.g. chocolate, ice cream, biscuits, cake, improved my ALT and brought it back into range by a substantial amount. Sadly, I'm rather fond of sugary junk and my ALT does increase sometimes.

One thing that a lot of people get told by doctors and various websites is that the way to reduce fat in the liver is by reducing fat intake. Not true! To reduce fat in the liver people have to reduce sugar.

[Edit : I did make changes to my fat intake a few years ago. I stopped using any fats and oils that needed to be processed in a laboratory to make them. I now only use fats and oils that people born somewhere on the planet 200 years ago would recognise as a fat or an oil. This means that I use butter, ghee, coconut oil, olive oil, beef fat. I would use lard as well but I don't like it.]

[sparkly]

Hi, it's very possible that you could fatty liver and if so possibly down to your thyroid.I had raised ALT's for a while and my Endo sent me for ultrasound. I had fatty liver and gallstones

This would either be down to low calorie/fat/carb diet for years or my thyroid. I know which I think is to blame!

I've likely reversed the fatty liver but without scans I can't say for certain. All my iffy bloods now normal, liver, kidney, cholesterols, crp and finally able to lose some weight.

Diet change of INCREASED calories, high protein, healthy fats and carbs. Exercising of resistance training and walking, minimal alcohol, good sleep and hydration. My T3 only dose has also increased and is more stable than ever.

So for me personally, it must have been better diet and exercise that allowed for my T3 to work better, as I'd been on higher doses in the past but it had not helped with reversing all the things that likely impeded the T3 from reversing things.

From my experience, if fatty liver is mild to moderate and hasn't progressed, then you are just left to get on with it. Fatty liver is seen as a lifestyle disease that a lot of the population have.

When in fact for us with thyroid issues, it can have nothing to do with what we eat but solely caused because of our thyroid.

I personally now feel that reversing fatty liver/ reducing liver enzymes is so important if you have thyroid issues. It was catch 22 for years. I couldn't reduce liver as couldn't lose weight, and I couldn't lose weight because i couldn't reduce liver.

[Bridkid67 in reply to sparkly]

Yea had a ultrasound a while ago it showed my liver as having fatty liver Dr said tweek your diet etc then after that I was diagnosed hypothyroidism in 2022 so it seems to all go in hand doesn't it ?

[sparkly in reply to Bridkid67]

Yes absolutely. I'm sure I had raised ALT's before diagnosed too.

[ThyroidDeb]

Your diet and not medications is the most likely culprit. I had higher numbers when I had fatty liver. While waiting for a hepotoligist appointment, try cutting out bad fats, sugar, white flour, white potatoes, eat lean meats, lots of vegies and fruits, no juices or sodas, watch what type of sugar replacements you might use. If you like fish eat couple times a week if not (like me) use supplements., use Olive Oil. Not sure of your weight but they say 5% body weight loss can bring numbers down. An US can view your liver for fat or enlargement. Good luck.

[Bridkid67 in reply to ThyroidDeb]

Yea will I don't drink so not a problem going to tweek my diet etc on allopurinol and rampiral as well and I take fish oil and garlic and B complex daily but must admit last few weeks I've slipped a bit and eaten some crappy food etc lol .

[ThyroidDeb in reply to Bridkid67]

I know it's hard. After my diagnosis 4 years ago I immediately changed my habits. I was first told I had fatty liver then after all the test from a gastroligist, that went to stage 4 cirrhosis with advanced fatty liver. I was in shock and scared so it made it easy to change my habits. The gastroligist was happy to stay with this diagnosis but I went for a 2nd opinion. New doctor said that just by looking at my chest and face, he didn't think I had cirrhosis, no little veins. One test I had he doesn't believe in, fibroscan, so he suggested biopsy. That showed Stage 1 fibrosis no cirrhosis and mild fatty liver. I, every 3 months have regular blood work from primary, from hepotoligist, every 6 months he has me get a US and 2 special blood test. Watching for liver cancer. However, after all these years, it's so hard to keep up on the diet change and exercise. I lost 80 pounds but gained back 15 over the past holidays and it's hard getting them back off!!!! I don't drink either but am a carb and sweets fan!! Lol

[Bridkid67 in reply to ThyroidDeb]

Hi just heard form my Drs she said just referring me as 2 enzyme levels were slightly elevated one been 37 when the range is up to 35 and the other 56 when the range is up to 44 but each lab is different?

[ThyroidDeb in reply to Bridkid67]

Better safe than sorry. A lot of Doctors ignore it then sometimes you might find out too late. Caught early can be reversed.

[ThyroidDeb]

Oh yes, alchohol, cut that out, even wine.

[Ozzy14]

My recent blood tests also show a slight elevation in liver enzymes. My GP said it’s related to my Hashimotos. I’m hypothyroid at the moment . So just had an increase in levothyroxine. Repeating bloods in 6 weeks.

[klr31]

I think liver abnormalities and thyroid problems are linked. Mine have been abnormal for some time.

[Bridkid67 in reply to klr31]

Yea seems to be my 2 enzymes levels are 37 when 35 is the upper limit and 56 when the upper limit is 44 depends on which limit each lab uses i think .

[klr31 in reply to Bridkid67]

So not too much over the top of the reference range.

[Bridkid67 in reply to klr31]

Yea but because it's happened a couple of times they want to make sure and refer me .

[Tina_Maria]

What are your actual thyroid results? Have you got a recent TSH, T4 and most importantly T3?

In many cases, the elevated liver enzymes are due to not having enough T3 available for your metabolism, so your liver cannot process lipids (cholesterol and other fats), glucose or proteins effectively. And because this process is impaired due to the low availability of T3, your liver enzymes rise as a compensatory mechanism, as the liver is trying to deal with this.

Are you still on only 75mcg of levothyroxine? Unless you are very small, this will be far too low a dose and hence this could be the explanation for your elevated cholesterol as well (a known side effect of hypothyroidism).

A general replacement dose of levothyroxine is 1.6mcg per kg of body weight. So, for example, if you weigh 75kg, you would need 120mcg of levothyroxine, rounded to the nearest 25mcg - so you should be on 125mcg!

cks.nice.org.uk/topics/hypo...

The reason why they probably have not increased it is that your TSH might be low and this always sends them into panic mode. But you can seriously ask them why you are only on 75mcg, when your body weight would suggest x amount of levothyroxine (according to your weight) as a replacement dose. The TSH should not be a guide at all, as it can be falsely low in people with thyroid dysfunction and the Free T4 and T3 should be the guide for appropriate treatment.

[Bridkid67 in reply to Tina_Maria]

Lol iam not small about 5'10 and 15.5 stone about i know i need to lose some timber lol they have only tested my TSH last one was 1.9 and the most recent said it was in range etc yea still on 75mcg they will only test TSH .

[Tina_Maria in reply to Bridkid67]

Well, this is most likely the root of all your problems. Most people feel well with a TSH around 1, but if you have never tested your free T4 and T3, you would not know where they sit and it could mean that they are still quite low, especially your T3, which is the driver of your metabolism.

In normal healthy people, the TSH guides the thyroid with regulating T4 and T3 levels. When T4 and T3 drop, the TSH goes high and the thyroid stimulates the production of hormones. When hormone levels are high, the TSH goes lower and the production of thyroid hormones ceases again. In people with thyroid disease, this feedback is not always working as it should and especially when you give T4, the T4 can lower your TSH quite dramatically, even though your T4 and T3 are still very low (and normally the TSH would still be high). But if you dose by TSH, you cannot see where your actual hormones are and hence you are severely under-treated. For your weight you should actually be on twice your medication, namely 150mcg levothyroxine. And because your metabolism is slowed down, this is why you might carry some extra weight and why it will be difficult to lose it again. It is not a dietary problem, it is a metabolic problem!

And this is why your cholesterol is so high, as you don't have enough thyroid hormones to deal with it and your liver enzymes are elevated, as your metabolism struggles. Even the NHS recognises high cholesterol as a side effect of hypothyroidism and advocates treating this before treating your cholesterol. And if they had done that and treated you correctly, you would not have needed a statin to deal with the cholesterol, as that would resolve itself, if the thyroid is treated correctly!

If your GP will not test T4 and T3, I would do a private thyroid function test (Monitor My Health do a good one, with THYROIDUK10 you get 10% off) and check where your levels are. I suspect that they are very low and that you urgently need an increase in levothyroxine. Are you symptomatic? You could say to the GP that you don't feel well on your current dose and that you would like an increase in your medication (and with a TSH of 1.9 they cannot yet argue that it is too low!).

If the GP is stubborn or unresponsive, might it be possible to see someone else or change practice? I just feel in the long term that you may be better off with a different treatment approach as leaving you on just 75mcg will very likely make you more and more ill.

[Bridkid67 in reply to Tina_Maria]

Yea going to test private i think my Dr is ok really but they tend to forget about thyroid patients once they put them on Levothyroxine etc they don't seem to bother with us unless we make a noise about it which I am going to do .

[Tina_Maria in reply to Bridkid67]

Definitely worth getting a private thyroid test and then see where you really are. I know, GPs just think we are okay as long as we are given some levothyroxine and the TSH is anywhere within that range 🙄.... sadly this approach does not work. Indeed, make a big noise and I hope you will start turning a corner soon.

[Bridkid67 in reply to Tina_Maria]

Thanks Think GPs need to brush up on thyroid conditions etc 😀

[Tina_Maria in reply to Bridkid67]

Absolutely!! 👍😉