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What Does My Blood Test Report Indicate?
Question: I am a 54 year old female. I was just diagnoised with Hyperthyroidism. My endocrinologist put me on Methimazole 5mg 2x a day for 5 weeks. I just had blood work done.
AST 43 range 15-37U/L
ALT 177 range 12-78 U/L
Free Thyroxine 1.08 range 0.76- 1.76 ng/dl
thyroid ultrasound no goiter or nodules.
TSH <0.01 range 0.36- 3.74 uIU/mL
TSI 388 range 0-139%
all my other labs were normal CBC
I am concerned about the liver and TSI TSH when I have been on the Tyroid Medication.
Please advise.
Thanks
thyroid hypo runs in family too
AST 43 range 15-37U/L
ALT 177 range 12-78 U/L
Free Thyroxine 1.08 range 0.76- 1.76 ng/dl
thyroid ultrasound no goiter or nodules.
TSH <0.01 range 0.36- 3.74 uIU/mL
TSI 388 range 0-139%
all my other labs were normal CBC
I am concerned about the liver and TSI TSH when I have been on the Tyroid Medication.
Please advise.
Thanks
thyroid hypo runs in family too
Brief Answer:
You have to opt for other treatments
Detailed Answer:
Hi XXXX.
Welcome to HCM. I have gone through the question and understand your concerns.
Have you done a liver function tests before treatment?
Regarding your question
1. Liver function
Methimazole can alter the liver function tests and is a dose limiting side effect. Hyperthyroidism can also alter liver function. So if you have a previous liver function report, we can say whether this is due to Methimazole or not. Any how if the liver function is elevated you will have to discontinue the medication after consulting your endocrinologist. You have to opt for other treatments like radio iodine treatment or surgery.
2. Regarding TSI
This is thyroid stimulating immunoglobulin, which when elevated suggest that you have hyperthyroidism due to Graves' disease (auto immune). Higher levels suggest less response to medical treatment.
3. Your thyroid function reports
T4 is normal and TSH is low. TSH takes longer time to normalise.
Hope I have answered your questions. If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
You have to opt for other treatments
Detailed Answer:
Hi XXXX.
Welcome to HCM. I have gone through the question and understand your concerns.
Have you done a liver function tests before treatment?
Regarding your question
1. Liver function
Methimazole can alter the liver function tests and is a dose limiting side effect. Hyperthyroidism can also alter liver function. So if you have a previous liver function report, we can say whether this is due to Methimazole or not. Any how if the liver function is elevated you will have to discontinue the medication after consulting your endocrinologist. You have to opt for other treatments like radio iodine treatment or surgery.
2. Regarding TSI
This is thyroid stimulating immunoglobulin, which when elevated suggest that you have hyperthyroidism due to Graves' disease (auto immune). Higher levels suggest less response to medical treatment.
3. Your thyroid function reports
T4 is normal and TSH is low. TSH takes longer time to normalise.
Hope I have answered your questions. If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Yogesh D
I just have one more question is my TSI really high?or slightly high? With the numbers I gave you?
I have only been on this medication for 5 weeks.
6 months ago all my labs were normal always great numbers liver thyroid cholesterol...
It just came on all of a sudden rapid heart beat one day frightened me I went to a cardiologist that checked my heart and took blood test that's when I found out I had hyperthyroidisum.
I also run every other day my Endocrologist told me not to exercise until my thyroid is functioning normally.
Thank you XXXX
I have only been on this medication for 5 weeks.
6 months ago all my labs were normal always great numbers liver thyroid cholesterol...
It just came on all of a sudden rapid heart beat one day frightened me I went to a cardiologist that checked my heart and took blood test that's when I found out I had hyperthyroidisum.
I also run every other day my Endocrologist told me not to exercise until my thyroid is functioning normally.
Thank you XXXX
Brief Answer:
TSI is moderately elevated
Detailed Answer:
Hi XXXXXXX
Welcome back.
Unlike the thyroid function tests, the values of antibodies are not standardised ( That means each lab will have a normal value based on the type of assay they use). So we have to take the normal from your lab tests. Here up to 139. So your value is moderately elevated ( Neither too high like > 1000 or slightly like less than 200). We have to take your value significantly elevated.
Our concern here is not the elevated antibodies but the elevated liver function tests. When liver enzymes are elevated it is better to stop the medications. If your endocrinologist prefers to continue medications repeat the liver enzymes periodically to see it is coming down.
You can discuss other options like radio iodine treatment (which is not with much side effects) to your endocrinologist.
Wishing you early recovery
Regards
Dr Ajish TP
Consultant Endocrinologist
TSI is moderately elevated
Detailed Answer:
Hi XXXXXXX
Welcome back.
Unlike the thyroid function tests, the values of antibodies are not standardised ( That means each lab will have a normal value based on the type of assay they use). So we have to take the normal from your lab tests. Here up to 139. So your value is moderately elevated ( Neither too high like > 1000 or slightly like less than 200). We have to take your value significantly elevated.
Our concern here is not the elevated antibodies but the elevated liver function tests. When liver enzymes are elevated it is better to stop the medications. If your endocrinologist prefers to continue medications repeat the liver enzymes periodically to see it is coming down.
You can discuss other options like radio iodine treatment (which is not with much side effects) to your endocrinologist.
Wishing you early recovery
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much:) promise last follow up question.
I just have never had liver enzymes elevated in my whole 54 years just kind of concerns me, my last blood test a month ago before starting the medication my liver
ALT was 56 now it's 177?
AST was 19 now 43
it's only been 5 weeks on the medication, if you were in my situation what would you do? Stay on the medication and see if numbers goes down or get off the medication asap?
just kind of scared... evryone I talk to has HYPO not Hyper
I just have never had liver enzymes elevated in my whole 54 years just kind of concerns me, my last blood test a month ago before starting the medication my liver
ALT was 56 now it's 177?
AST was 19 now 43
it's only been 5 weeks on the medication, if you were in my situation what would you do? Stay on the medication and see if numbers goes down or get off the medication asap?
just kind of scared... evryone I talk to has HYPO not Hyper
Brief Answer:
It is better to discontinue medication
Detailed Answer:
Hi XXXXXXX
Welcome back.
I will explain the treatment of hyperthyroidism to clear all your questions.
You are having hyperthyroidism due to thyroid stimulating antibodies. This condition is called Graves' disease.
There are 3 treatment options for Graves' disease
1. Anti thyroid drugs - Methimazole
This drug can control hyperthyroidism, but can CURE hyperthyroidism in only 40% of patients if treated continuously for 18-24 months.
So this drug is a not a curative treatment for majority.
Major concern of this drug is side effects. It can cause altered liver function and decrease your white blood cell count. This side effects are seen in one in every 1000 patients treated. Once these side effects are there it is better to decrease or stop the medications. This is because it can rarely cause liver cell failure. Since the Methimazole is not 100% effective and we have other safe options it is better to discontinue the medication.
2. Radio iodine treatment
Here we take a small dose of radio iodine -single dose. The radio iodine will concentrate in your thyroid and destroy your thyroid gland, making you hypothyroid.
This treatment is 90% effective and brings down your thyroid hormones in 1-3 months.
If you come in 10%, you can take a second dose of radio iodine.
This will not cause side effects of radiation as the dose is very small. You just need to be away from pregnant women and children for 2 weeks. This is the preferred 1st line treatment in many countries.
3. Surgery -thyroidectomy
Here thyroid gland is removed completely. There is 100% cure rate immediately after surgery. Problems are surgical complications and higher costs.
Most doctors prefer medications first to control the disease followed by radio iodine treatment in those who do not respond or with side effects of medications.
In my practice I won't continue the medications in those with elevated liver enzymes. This is because I won't take a risk with a medication that is having only 40% cure rate when I have better option. Discuss about this with your doctor.
Hope this will clear your questions.
Wishing you early recovery
Regards
Dr Ajish TP
Consultant Endocrinologist
It is better to discontinue medication
Detailed Answer:
Hi XXXXXXX
Welcome back.
I will explain the treatment of hyperthyroidism to clear all your questions.
You are having hyperthyroidism due to thyroid stimulating antibodies. This condition is called Graves' disease.
There are 3 treatment options for Graves' disease
1. Anti thyroid drugs - Methimazole
This drug can control hyperthyroidism, but can CURE hyperthyroidism in only 40% of patients if treated continuously for 18-24 months.
So this drug is a not a curative treatment for majority.
Major concern of this drug is side effects. It can cause altered liver function and decrease your white blood cell count. This side effects are seen in one in every 1000 patients treated. Once these side effects are there it is better to decrease or stop the medications. This is because it can rarely cause liver cell failure. Since the Methimazole is not 100% effective and we have other safe options it is better to discontinue the medication.
2. Radio iodine treatment
Here we take a small dose of radio iodine -single dose. The radio iodine will concentrate in your thyroid and destroy your thyroid gland, making you hypothyroid.
This treatment is 90% effective and brings down your thyroid hormones in 1-3 months.
If you come in 10%, you can take a second dose of radio iodine.
This will not cause side effects of radiation as the dose is very small. You just need to be away from pregnant women and children for 2 weeks. This is the preferred 1st line treatment in many countries.
3. Surgery -thyroidectomy
Here thyroid gland is removed completely. There is 100% cure rate immediately after surgery. Problems are surgical complications and higher costs.
Most doctors prefer medications first to control the disease followed by radio iodine treatment in those who do not respond or with side effects of medications.
In my practice I won't continue the medications in those with elevated liver enzymes. This is because I won't take a risk with a medication that is having only 40% cure rate when I have better option. Discuss about this with your doctor.
Hope this will clear your questions.
Wishing you early recovery
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you so much! you answered all of my questions:)
Brief Answer:
Get well soon
Detailed Answer:
Hi XXXXXXX
It's great to know that the information I have you was helpful to you during your illness.
If you have any further questions during treatment of your illness please feel free to ask.
Get well soon
Dr Ajish TP
Consultant Endocrinologist
Get well soon
Detailed Answer:
Hi XXXXXXX
It's great to know that the information I have you was helpful to you during your illness.
If you have any further questions during treatment of your illness please feel free to ask.
Get well soon
Dr Ajish TP
Consultant Endocrinologist
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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