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What Do My Lab Test Results Indicate?

Posted on Sat, 31 Oct 2015

Question: Hi Dr Sanghvi

You may remember a few days ago I contacted you recently about my raised ALT of 74 with other LFT normal and raised TSH at 6.4 with normal T3 and T4. You very kindly reassured me to have LFT repeated and to have thyroid antibodies.

I have had the LFTS repeated and ALT is now 47. TFTs taken at same time (2 days ago) now show TSH at 13 with normal T3 and T4.

Please could you advise on latest results.

Thanks XXXX

Answered by Dr. Hardik Sanghvi (3 hours later)

Brief Answer:
You have hypothyroidism.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

Your ALT comes down to normal so nothing to worry about that.

Your TSH level is increased further with normal T3 and T4.

You have sub clinical hypothyroidism.

Most common cause of hypothyroidism is Hashimotos thyroiditis.
However transient rise in TSH may occur sometimes without any disease.

But you should investigate for thyroiditis once for early detection.
You should go for TPO antibody test and free T4 level.

It will give you exact idea. Then you should take further treatment accordingly.

Hope I have answered your question. If you a have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (2 hours later)

Thanks. Yes good news re ALT. I asked my GP for thyroid antibodies and he said they were not necessary and to start levothyroxine immediately. I have asked for the test regardless and should have results in next day or so. I shall wait until results of antibodies before starting medication and let you know results? Thanks

Answered by Dr. Hardik Sanghvi (2 hours later)

Brief Answer:
Levothyroxin is needed.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Yes you have hypothyroidism so levothyroxin is needed but still you should go for antibody test. Because if it is hashimotos thyroiditis then other treatment is also required. Please give me follow up with your reports. You can start levothyroxin without waiting for reports.

Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Hardik Sanghvi (2 hours later)

Ok thanks will start the tablets. I'm worried the tablets could set off my AF again! What situation would allow me to stop taking the levothyrixine please further down the line? Thanks XXXX

Answered by Dr. Hardik Sanghvi (13 hours later)

Brief Answer:
Over dosage can leads to arrhythmia.

Detailed Answer:
Hi, dear
I have gone though your question. I can understand your concern.

You should start with minimal dosage because high dosages can increase the sympathetic activity and coronary events or arrhythmia can precipitated.
So start with minimal required dosage. It will avoid development of hypothyroid symptoms.

Generally life long treatment is needed. But once dosage is set, semiannual assessment is required.

Hope I have answered your question. If you have doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hardik Sanghvi (59 minutes later)

Thanks. Will start with low dose and see how it goes. Will let you know thyroid antibody results. Just to be sure are there any further tests I should have done? Was kind of linking the paroxysmal AF with the suddenly raised ALT (although normal on last test) and now TSH. Was worried there was done other explanation such as carcinoma, sarcoidosis etc etc

Thanks

Answered by Dr. Hardik Sanghvi (4 minutes later)

Brief Answer:
Thyroid antibodies test and free T4 level are required.

Detailed Answer:
Hi, dear
I have gone through your question. i can understand your concern.
Thyroid antibodies test and free T4 level are required. No other test required at this stage. Don't worry much about that. it is not related with your paroxysmal AF.

Give me fallow up with test results. Start levothyroxin according to your doctor's advice because it is prescription based medicine.

Hope I have answered your question. If you have doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hardik Sanghvi (25 hours later)

Hi XXXXXXX I have been back to the medical centre and thyroid antibodies are all completely normal. They have advised to hold off on the levothyroxine due to antibody test and being asymptomatic and retest in 6 months and have thyroid ultrasound in meantime too. Thanks XXXX

Answered by Dr. Hardik Sanghvi (13 hours later)

Brief Answer:
You should retest after 3 months.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
It is good news that your antibody test is negative.

So now you have subclinical hypothyroidism with only with high TSH and normal t3 and t4.

Whether to start with levothyroxin or not is controversial in asymptomatic cases. Some physician start the treatment with TSH level more than 10. However transiant rise in TSH is one issues.

Many physician goes with wait and watch approach.

If your physician says that ypu should hold off with levothyroxin then yhere is no harm in that.

But in my opinion you should not wait for 6 months. Just repeat your TSH after 3 months. If it comes to normal then its ok. And if it increase further after 3 months then you should start treatment irrespective of symptoms to avoid symptomatic hypothyroidism.

Go for ultrasound neck and if youphave any nodule then fine needle aspiration cytology is also helpful.

Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (3 hours later)

Pranks I thought 3 months best too and have booked a repeat TSH, T3, T4 then. They have advised an US thyroid too which I will organise. Thanks for all your help. XXXX

Answered by Dr. Hardik Sanghvi (5 minutes later)

Brief Answer:
You are most welcome.

Detailed Answer:
You are most welcome.
Ask me any time if you need any further help. I will be happy to answer.

Thanks for using health care magic.
Wish you a very good health.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar