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Hyperthyroidism and Liver Function

Hello everyone. So a little backstory first.

I was diagnosed with Graves disease back in 2013-2014. I was put on the methimazole + beta blocker treatment. I went into remission around 2016, when all my labs were normal. So I stopped the meds.

Then, March of 2018, Graves was back with a vengeance. All the telltale signs were back, the excessive heat and heart palpitations, I went back to the doctor and back on drug treatment. This time, however, the meds doesn't work whatsoever. Months after months, TSH are still super low.

Doctor started to push for RAI treatment, but I really didn't want something so irreversible. So I stayed on the methimazole + beta blocker combo. Then, starting from August of 2018, my labs started to show high to very high values for the metabolic panel (SGOT and SGPT). The first thing came to mind was that methimazole's side effect was starting to show. Doctor and I decided on the wait and see approach, so I stayed on the meds. We have also ruled out Hepatitis.

Back in May, I am finally starting to consider RAI. We decided to do the uptake scan first to see how my thyroid's been. So I stopped taking methimazole mid-May. The update scan in June just re-confirmed everything we've known so far - Graves disease and abnormally large thyroid.

My latest labs came back, and here are the main numbers:

TSH (L) <0.010
Free T4 (H) 1.54
T3 Total (within normal range) 108
SGOT(AST) (H) 71
SGPT(ALT) (H!) 225

So, even stopping methimazole for a month now, my liver function is still very alarming. I've been reading up on hyperthyroidism and liver dysfunctions and there seems to have studies that suggest they are linked. But should I be worried that there is something else going on?

I am still debating about RAI. I'm scared about doing something so irreversible and going hypo. Ideally, I would prefer to stay with the drug therapy, but statistically, drugs won't work for people like me with recurrence Graves hyperthyroidism after the initial remission.

I haven't schedule RAI yet. I guess before I shrink my thyroid, I'm wondering if I should find out that my liver's problem actually have anything to do with my thyroid first.

Advices appreciated.
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1756321 tn?1547095325
Both hyperthyroidism and anti-thyroid medication can affect the function of the liver causing increases in liver enzymes. Liver damage is more common with the anti-thyroid drug Propylthiouracil. I have gathered together this information from numerous sources and various studies...

Conventional treatment options for Graves' disease include:

* Anti-thyroid medication:

Propylthiouracil [PTU]

Anti-thyroid medications decrease the level of thyroid hormones thyroxine (T4) and triiodothyronine (T3).  Approximately 30% with Grave's disease will have a remission after prolonged treatment with anti-thyroid medication.

Side effects of anti-thyroid medication:

Minor side effects: [up to 15%] - itching, rash, hives, joint pain and swelling, fever, changes in taste, nausea, and vomiting.

Major side effects:

Agranulocytosis [1 in every 200 to 500] - severe decrease in the production of white blood cells. More commonly occurs within the first 3 months but can occur at any time.

Liver damage [more common with PTU], aplastic anaemia [failure of the bone marrow to produce blood cells], vasculitis [inflammation of blood vessels associated with PTU].

* Betablockers - does not block the production of thyroid hormone but can help with symptoms such as rapid heart rate, trembling, anxiety.

The two following treatment options usually cause permanent hypothyroidism requiring lifelong thyroid hormone therapy:

* RAI [radioactive iodine] therapy]

* Surgery [most or all the thyroid gland is removed]

Note: there is the option of Endoscopic Axillary Underarm Thyroidectomy. The underarm endoscopic surgery involves very little bleeding, minimal incisions, and no visible scars in the neck.

Alternative/natural treatments for Graves' disease include:

Bugleweed [Lycopus virginicus]
Lemon Balm [Melissa officinalis]
Motherwort [Leonurus cardiaca]

Bugleweed is an anti-thyroid herb which has been shown to help reduce the symptoms of mild hyperthyroidism in human studies. Bugleweed has been shown to block TSH, decrease T4 and T3 and block the action of thyroid stimulating antibodies found in Grave's disease.

Lemon Balm is used to mildly reduce thyroid hormone levels and symptoms associated with hyperthyroidism. Lemon Balm inhibits TSH receptor binding which causes a decrease production of T3 and T4 in the thyroid gland. Test tube studies have found that Lemon Balm blocks attachment of antibodies to the thyroid cells that cause Grave's disease.

Motherwort helps to alleviate symptoms related to a hyperactive thyroid. This herb is a natural beta blocker as it can help with symptoms such as tachycardia [high heart rate], and palpitations.

* Over consumption of uncooked goitrogenic foods can depress thyroid activity: brussels sprouts, cabbage of all kinds, cauliflower, kale, kohlrabi, peaches, pears, rapini, spinach, strawberries, radishes, rutabagas, turnips, soybeans, pine nuts, peanuts, millet, rape seed [canola oil].

* One study demonstrated that selenium [200 mcg daily] significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy [thyroid eye disease].

*An amino acid called L-carnitine has been shown to inhibit thyroid activity and may help prevent the possible lethal outcome of a thyroid storm. L-carnitine can be take alone or with anti-thyroid medication.

*Low Dose Nalrexone [LDN] can reduce symptoms in autoimmune conditions. There are no clinical trials in regards to LDN and autoimmune thyroid diseases however one survey found that 38% of patients reported spectacular results after they started taking LDN, 48% were able to decrease the level of thyroid antibodies, 40% of patients reported reductions in pain, 61% saw improvement in their mood and 66% experienced an energy boost.
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