Help understanding my symptoms

[FLG8R]

        Fasting        Fasting
BLOOD TESTS - 12/4/2006 12/30/2006 1/3/2007
ALT (3 - 40) 61           190
SGPT (7 - 55)     179
AST (3 - 35) 27     108           104

TSH        9.55     2.55   3.77

Cholesterol Total 220            254
LDL (< 130) 143            166
DHL (> or = 40) 63             67

Glucose (65 - 99)101     127             88

Platelet Count
(140 - 400 Thous/uL)300            371

APTT (25-35 seconds)      37

All other test results were normal but where no info listed above, test not done on that date

12/6/2006 started Lexapro 10 daily & Synthroid 50 daily, increased to 100 daily on 12/20/06.  On 12/30/06 I had severe cramping and spasms in my legs.  Stopped Lexapro on 12/30/06.  My legs are much improved so long as I don’t overdo it/stand for too long.  Hepatitis profile from 1/4/07 blood test not received yet.  1/5/07 liver ultrasound was normal although the area of liver is still very tender hurts to touch.

I now realize I have had many symptoms (both re Thyroid and Liver) for many months some as many as 9-12 months including but not limited to –
· itching which is nearly unbearable now
· frequents headaches only for last 2 yrs
· difficulty concentrating & forgetfulness, loss for words when speaking – I have had to take a unpaid leave of absence from work due to these mental problems
· fatigue - generally very weak, dizzy/lightheaded if I exert myself too much (sleeping 12 – 16 hours daily for at least 2 months)
· blurry vision, perception off – misjudge, seem to be having difficulty focusing
· eyes itchy, mucuosy
· thinning hair, outer eyebrow disappeared
· unusually dry rough skin
· Bleed/bruise easily & slow to clot
· Weight gain 15 lbs in past year, about 8 of which in past 3 months
· Dark/strong urine
· Stiff muscles/joints – difficulty standing after sitting for about 30 minutes

I have done some reading the past week or so and do not have any hepatitis symptoms other than those which are listed above.
I understand that my platecount count would indicate minimal liver damage.  Is that true?

Based on my reading I suspect if liver problem likely caused by toxin (chemical) or tylenol although I nver took more than daily dose I have taken.  

If my situation is caused by toxin then does it resolve itself once the exposure/ingestion of toxin stops?

Are my symptoms and blood test results conclusive proof of liver disease/damage? Is it possible to have liver disease without having liver damage, or vice versa?  

Does the sharp rise in ALT/AST over short time period along with more pronounced symptoms indicate problem which is quickly getting worse?  If so what timeframe is significant, days/weeks/months?

Many, many thanks for your insight as my doctor has not told me anything at all other than there is a problem with your liver. I am waiting for appointment with gastro dr.

[Kevin Pho, MD]

To answer your questions:
1) An elevated platelet count can be present with an infectious or inflammatory process.  However, yours came within normal limits.

2) Testing for various toxins can be considered.  However, I would first obtain an ultrasound to image the anatomy of the liver.  With the itching, blood tests can be done to evaluate for primary biliary cirrhosis.

3) Early liver disease can be present without permanent liver damage.  Again the ultrasound would help.  If the diagnosis is still in question, a liver biopsy can be considered.

4) That would depend on the cause.

I would discuss these questions with your personal physician, along with a GI specialist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_