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undetectable - High lvr enzymes
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undetectable - High lvr enzymes

Hello - I am approaching my 7th month of triple therapy, now w/just the Ribiviran and Interon. 3 pcrs including the most recent one have brought back "under a 100 copies" which my Dr. says is what we want. He says that's considered undetectable. I also get other lab work done every 6 weeks. My most recent lab work shows liver enzymes around 135 when all along they have been around 75 to 80. Is this considered extremely high for under a 100 copies? When the pcr shows undetectable do most people's liver enzymes go down into the normal range?

My primary care physician is also working with my gastoral enterologist(sp). My PCP is having a hard time regulating my tsh(thyroid) while I have been on this treatment.  I am wondering if that may be causing the high liver enzymes.  I am due for more lab work in a few weeks.  Do you think I should wait and see that the results say since my PCP just adjusted my thyroid medicine or do you think I should insist on tests for fatty liver and/ or AIH?
11 Comments Post a Comment
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163305_tn?1333672171
I'm not the best at interpreting tests but I know that no PCR will show undetected entirely. Most show und  below 40 or even one goes as low as below 5.
I'm not sure what lab your doctor is using but if 100 is the lowest, and you are below that, then yes, you're considered und.
Congratulation, that's wonderful news.

Liver enzymes often jump around during tx. I wouldn't worry about that. I'd be more concerned about your thyroid.

Yes, thyroid problems are not unheard of as a possible side effect during treatment.

Your situation underscores why it is preferable to have an experienced hepatologist ( liver specialist) rather than a GI or PCP overseeing your treatment.

Hopefully someone else will reply soon with more help for you.
Good luck.
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1815939_tn?1377995399
Welcome to the forum.

It may be helpful to give us a little more information about yourself so that we can better respond to your questions.

Obviously you are Genotype 1.
What is your liver biopsy result?
Did you treat with Incivek or with Victrelis?

I am not sure why your doctor is using a PCR test which is detectable down to only 100. The protocol recommends using a test that can quantify down to 25 (but can detect lower than that), although many docs use a test that quantifies to 43 (but can detect lower than that).

Do you have copies of your HCV PCR. If you do, can you please type in exactly what the result says.

At what week were you undetectable? It should state UND on your lab copy.

What is the  reason you are doing 48 weeks of treatment?

Liver enzymes do jump around while on treatment but, if it was me,  I would want to see exactly what those PCR tests state. My liver enzymes jumped around between 20 and 50 at the beginning of Tx but stabilized at about 15 and 18 by the 4th or 5th month.

Here is a link that takes you to a page listing the causes of elevated liver enzymes.

http://www.mayoclinic.com/health/elevated-liver-enzymes/MY00508/DSECTION=causes

If it was me, I would want my doc to look into other possible complications and causes.
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Avatar_m_tn
Thanks alot for checking in.
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Avatar_m_tn
Hey, thanks for your reply. I'll post parts of the pcr when I get home later.
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766573_tn?1365170066
I think if it were me I would at least one time during treatment request a PCR with a more sensitive detection limit. I understand that in the clinical trials, PCR of <25 IU/mL undetectable by Roche COBAS Taqman HCV test was used.
http://www.medhelp.org/user_photos/show/310915?personal_page_id=414409


But most important according to the Incivek treatment rules treatment duration for week 12 is determined by a VL  ≥ 100 copies. And in order to proceed with treatment at week 24 it is necessary that one be UND.

____________________-
What was your baseline TSH and what is your current TSH?
I am assuming your TSH spiked and you became Hypothyroid during treatment. If (IF) you started thyroid meds during treatment it can take a while to find a therapeutic range. I think 6 week labs is too far apart and it could take some time to balance things out with that big of a gap.

I can only base this on personal experience since I became Hypo at week 13. I had my TSH (and a thyroid panel) checked at a two week interval the first time (since it went up to 17.6) and then just my TSH every three weeks after that. All in all it took about 4 months to find a dose that regulated my TSH.

I will let someone else respond to a possible relationship between TSH and liver enzymes. It will help to know what your current and baseline values.

Best of luck
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Avatar_f_tn
I cannot address the relationship between TSH and elevated liver enzymes, but I will tell you that my husband's enzymes remained elevated throughout his entire 24 week tx, and he has SVR'd.  Thought that might be reassuring, but I do agree with everyone above that you might want to consider a more sensitive PCR test.  
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766573_tn?1365170066
Ahoy.  I thought I would add this link related to the treatment monitoring and intervals for lab tests for Hypothyroidism. I do not want to mislead you by suggesting labs more frequently than necessary.  I had thyroid problems the first time I treated and apparently patients need close monitoring of thyroid if they are re-treated with IFNα. As a result the same circumstances may not apply to you.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2134787/


I am not sure if your doctor explained this to you but with some people TSH levels rebound after treatment; others are not so fortunate.


This is the American Association of Clinical Endocrinologists Medical Guidelines for the clinical practice for the Evaluation and Treatment of Hyperthyroidism and Hypothryoidism

1) treatment (levothyroxine) is started at a low dose (12.5-25 ug/day) and dose adjustments/labs "varying six to eight weeks but individualized for each case."

2) 2 weeks to several months may elapse before TSH responsiveness is recovered.

(PDF File - I just put a view only in Tinyurl)
http://tinyurl.com/cb6dmef

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Avatar_f_tn
http://www.ncbi.nlm.nih.gov/pubmed/17941901

CONCLUSIONS:

Our findings suggest that hypothyroidism and thyroid function tests, even within the reference range, are associated with slightly increased serum GGT and ALT activity concentrations.

************
Sorry but it would not let me post the entire article for some reason.  This is getting irritating because it wasn't that long grrr.  So I copied the conclusion.

Have a great day!

Jules
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Avatar_m_tn
Thanks for going through the trouble. I started taking levoxacyline for my thyroid about 15 years ago after I finished my first treatment for Hep C.  Back then my Dr. and my G.I. didn't tell me there was a connection.  They may not have known back then. Flash forward to now, I think the triple therapy definately impacted my thyroid, but my PCP just changed my dose of Lev. so hopefully I should be more stable now.  I'll know in a few weeks.
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3203287_tn?1346460234
During my first treatment, I got hypothyroidism and have had it ever sense (about 8 yrs).  I actually before this treatment after some weight loss was able to reduce my dose from 100 mcg synthroid to 88 mcg.  But now on triple tx, I'm high again so they are increasing my synthroid to 125 mcg.  Hope that does it, but if not, I have a feeling it will come back down somewhat after treatment like before.  If not, it's not an untreatable disease.  I hardly notice I have it until it gets out of whack and then I feel fatigue, weight gain, often cold.   They test mine often now since it seems to increase during treatment often.
Good luck on your treatment.  I'm in week 14 now and can't wait to finish.  I'm just glad to have incivek over...it was like a new beginning when I finished it.
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Avatar_m_tn
Yeah the Incivek was was different. I'm not one of those that suffered the massive side effects, but there were a couple. I also hated eating all that crap you had to eat with it.  As I said I am in month 7 and like you I just want to get this over with. Glad this treatment is here finally, but I hope I'll be glad when it's over.  Good luck with your treatment.
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