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What Do These Lab Reports Indicate?
Question: Hello
I have had elevated liver enzymes for 4 months now. Ast and alt mid forties. I have hashimotos disease with goiter. I saw a hepatologist and due to the fact I have elevated igg (29 on a scale of 18 being high normal) he tested me for autoimmune hepatitis. All tests were negative. He now says he could do a biopsy. Have been tested for hep a b c as week as had a ct scan ultrasound and fibroscan. All were normal. I'm not sure what to do now. Is it true that thyroid patients can also have an elevated igg? As of now that appears to be my only marker of autoimmune hep. Not sure if I should have a biopsy at this time. I am canadian and went to the U.S. to see this Dr. It will cost thousands to have the biopsy. It is a long wait in Canada to see the specialist.
I have had elevated liver enzymes for 4 months now. Ast and alt mid forties. I have hashimotos disease with goiter. I saw a hepatologist and due to the fact I have elevated igg (29 on a scale of 18 being high normal) he tested me for autoimmune hepatitis. All tests were negative. He now says he could do a biopsy. Have been tested for hep a b c as week as had a ct scan ultrasound and fibroscan. All were normal. I'm not sure what to do now. Is it true that thyroid patients can also have an elevated igg? As of now that appears to be my only marker of autoimmune hep. Not sure if I should have a biopsy at this time. I am canadian and went to the U.S. to see this Dr. It will cost thousands to have the biopsy. It is a long wait in Canada to see the specialist.
Brief Answer:
Detailed reports please. /
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: Elevated liver enzymes for 4 months - AST, AST mid forties - negative for autoimmune hepatitis - Hep A/B/C CT, USG, Fibroscan - all normal -
Also have Hashimoto's with raised igg -
Since Almost all the tests related to the liver are normal as we saw above except just raised ALT and AST, I do not find any reason to do liver biopsy at the moment.
You can get a review of the raised parameters after 1 month and then only to decide for further.
Liver biopsy is a potentially dangerous procedure and should be done only when indicated.
Please post the reports with reference values of normal range.
So that we can discuss further as you have Hashiimotos too.
Secondly What is the recent report of Free T3, Free T4 and TSH?
Please feel free ask relevant queries if you need to or if you feel that there is a gap-of-communication.
You may please post all the reports as scanned copies for me to study more to give a better and fruitful opinion.
Detailed reports please. /
Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
To recapitulate: Elevated liver enzymes for 4 months - AST, AST mid forties - negative for autoimmune hepatitis - Hep A/B/C CT, USG, Fibroscan - all normal -
Also have Hashimoto's with raised igg -
Since Almost all the tests related to the liver are normal as we saw above except just raised ALT and AST, I do not find any reason to do liver biopsy at the moment.
You can get a review of the raised parameters after 1 month and then only to decide for further.
Liver biopsy is a potentially dangerous procedure and should be done only when indicated.
Please post the reports with reference values of normal range.
So that we can discuss further as you have Hashiimotos too.
Secondly What is the recent report of Free T3, Free T4 and TSH?
Please feel free ask relevant queries if you need to or if you feel that there is a gap-of-communication.
You may please post all the reports as scanned copies for me to study more to give a better and fruitful opinion.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hello
I have uploaded my reports. Let me know when you receive them. My thyroid appears to be normal except for low free T3 I have noticed for quite sometime I feel a bit hyper thyroid though. I can eat whatever I want and never gain wait plus just feeling wired. My dr says its all in my head. Im not sure whats going on. The report shows my results for the past year. The most recent being on the right side.
I have uploaded my reports. Let me know when you receive them. My thyroid appears to be normal except for low free T3 I have noticed for quite sometime I feel a bit hyper thyroid though. I can eat whatever I want and never gain wait plus just feeling wired. My dr says its all in my head. Im not sure whats going on. The report shows my results for the past year. The most recent being on the right side.
Brief Answer:
As explained
Detailed Answer:
So nice of you that you provided the well placed reports.
I have read all.
ALT- 60/45/ 28 recent is normal (0-40)
Free T3 - 7 months ago was marginally low and not repeated ? not very important
GGT - 100/94/105/ 70 recent greatly reducing. (8-35)
Alkaline Phosp - 95/96/105 (30-115) = this is persistently normal.
AST - 45/47/ recent not done (8-35) marginally raised
IgA normal
IgG- 29.43 (6.8-18)
Lactate Dehydrogenase - 449 (100 -235), can occur in hypothyroidism, liver problems and many other condition. It reduction is prognostic of proper treatment.
As you have mentioned: Have been tested for hep a b c as week as had a ct scan ultrasound and fibroscan. All were normal.
Increased serum immunoglobulin concentrations occur due to polyclonal or oligoclonal immunoglobulin proliferation in hepatic disease (hepatitis, liver cirrhosis), connective tissue diseases, acute and chronic infections, this means it may not be specific for a certain disease and since all other investigations including fibroscan (measures liver fibrosis)is negative, biopsy can wait.
Repeat the tests after say not before 1 month and then decide.
The commonest cause of GGT elevation is Alcohol consumption and there are other reasons too that can elevate it.
ALT is more specific for liver and is normal in the most recent reports.
I would advise you the following:
Stop worrying as more important tests are negative or getting normalized.
Never touch the alcohol in any form and avoid all the medicines that can cause hepatic problems
I have tried my best to explain, correlate and simplify and I know this may not be the best opinion but now your ideas would become clearer and help you to take a decision.
As explained
Detailed Answer:
So nice of you that you provided the well placed reports.
I have read all.
ALT- 60/45/ 28 recent is normal (0-40)
Free T3 - 7 months ago was marginally low and not repeated ? not very important
GGT - 100/94/105/ 70 recent greatly reducing. (8-35)
Alkaline Phosp - 95/96/105 (30-115) = this is persistently normal.
AST - 45/47/ recent not done (8-35) marginally raised
IgA normal
IgG- 29.43 (6.8-18)
Lactate Dehydrogenase - 449 (100 -235), can occur in hypothyroidism, liver problems and many other condition. It reduction is prognostic of proper treatment.
As you have mentioned: Have been tested for hep a b c as week as had a ct scan ultrasound and fibroscan. All were normal.
Increased serum immunoglobulin concentrations occur due to polyclonal or oligoclonal immunoglobulin proliferation in hepatic disease (hepatitis, liver cirrhosis), connective tissue diseases, acute and chronic infections, this means it may not be specific for a certain disease and since all other investigations including fibroscan (measures liver fibrosis)is negative, biopsy can wait.
Repeat the tests after say not before 1 month and then decide.
The commonest cause of GGT elevation is Alcohol consumption and there are other reasons too that can elevate it.
ALT is more specific for liver and is normal in the most recent reports.
I would advise you the following:
Stop worrying as more important tests are negative or getting normalized.
Never touch the alcohol in any form and avoid all the medicines that can cause hepatic problems
I have tried my best to explain, correlate and simplify and I know this may not be the best opinion but now your ideas would become clearer and help you to take a decision.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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