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Thyroid In Relation to Liver Enzymes + Possible NAFLD

Okay, so here it goes…

I am only 23 years old, have been diagnosed with hypothyroidism since I was 20, and just now recently have gotten my TSH in check by switching from Levothyroxine to Synthroid (the Levo wasn’t controlling my TSH at all), but so far, the Synthroid had kept it in check very well in the 6 months I’ve been taking it. My TSH hovered around the 10-14 range when I was taking Levo for the 2.5 years previously, but the doctors kept just upping the dosage, I finally said that I failed the trial enough times and they agreed to switch me to Synthroid, and now it’s only been in the 1.5-3.5 range for the previous 6 months, which is great. But here’s where things get weird…

So I went to get a full blood panel done this past Friday and low and behold… my AST was 318 (normal is 10-40) and my ALT was 98 (normal is < 35). This immediately concerned the NP, for obvious reasons. Now, I don’t hardly ever drink, don’t smoke, don’t do any drugs, workout somewhat regularly and try my best to eat healthy nowadays. The only catch to all of that is that I usually will drink an energy drink (Monster) each night that I work my night shift nursing job in order to stay awake. The NP said that she wanted to repeat the lab in 3 days and for me to not drink anymore energy drinks in the meantime, so I didn’t drink any in the 3 day period that I waited to get labs done again, which was on Wednesday of this week. My lab results from that draw which came in earlier this morning were an AST of 58 and ALT of 55.

I was doing some research and it seems as if there’s a correlation between hypothyroidism, liver problems, and a possible diagnosis of NAFLD. My NP asked if NAFLD runs in my family, and it doesn’t. My parents are majorly hypothyroid though and have been receiving treatment for years.

My question is complicated, but I just want to know if anyone has gone through this same super strange issue / have gone through it, because the doctors looked at me as if was a binge drinker since I’m a 23 year old male. That’s far from the correct case. I would really appreciate any advice or guidance on this matter.

To summarize:
- had thyroid issues for 3+ years, just recently got TSH in check with the help of Synthroid switching from Levo
- recent lab panel showed extremely elevated liver enzymes values (AST and ALT), but normal bilirubin.
- wondering if there is a link between excess niacin in energy drinks, a weakened liver due to hypothyroidism?, and if I could potentially have NAFLD as a result of my uncontrolled TSH that went on for so long
2 Responses
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Avatar universal
Some doctors know the best way to treat hypothyroidism, but they find the current practice expedient, and it avoids peer pressure from doctors who don't want to treat clinically.   Others don't know about current scientific evidence to the contrary, so they just continue with the decades old practice.    And if your doctor is not willing to treat clinically, as described in the paper, you will continue to suffer with hypo symptoms and other related maladies.  One of the clearest pictures I have seen came from this link co-authored by Dr. Hoermann.  

https://www.hindawi.com/journals/jtr/2018/3239197/

Just scroll down to the graphs and click on c .  There on the y axis is the probability of having hypo symptoms.  You can see that with doses of T4 med up to 150 mcg, symptoms don't go away unless there is adequate FT3 levels. By the way, the red line represents a FT3 that is at 8% of its range, the green is 39%, and the blue is 57% of the range.   Compare that to the ATA statement that most hypothyroid patients are adequately treated with 100-125 mcg of T4.   Of course they are setting the dose based on TSH.  

By the way, what are your FT4 and FT3 levels, along with their ranges?  Also, if tested for Vitamin D, B12 and ferritin, please post those as well.  

You should give your doctor a copy of the paper and ask to be treated clinically, as described in the paper.  If he resists, then you will need to find a good thyroid doctor that will do so.  
Helpful - 0
1 Comments
If the doctor resists, ask him why use TSH to determine dosage when it has only a weak correlation with either of the actual thyroid hormones, and a negligible correlation with symptoms, which is what you are concerned with.  

By the way,  what is your current thyroid med and daily dosage?
Avatar universal
There is a link between hypothyroidism and NAFLD. Note this typical link on the subject.

https://www.frontiersin.org/articles/10.3389/fendo.2017.00335/full#:~:text=According%20to%20our%20study%2C%20hypothyroidism,higher%20risk%20of%20developing%20NAFLD.

Most important is that dosing your thyroid med based on TSH will keep you hypothyroid.   Thyroid med dosage should be based on relief of hypo symptoms, not TSH.  Rather than getting into the explanation for saying that, I recommend that you read my paper in the following link.  The paper is based on my 40+  years of being hypothyroid, my years of research on it, and my 14 years of participation on this Forum, trying to help other members.  One of my co-authors is a retired German Endocrinologist who has vast experience and knowledge, and has co-authored over 100 papers mostly on thyroid issues.  The paper is posted on a patient advocacy site in the UK.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

After you have a chance to read the paper, let's discuss further.  
Helpful - 0
2 Comments
I have read the paper in full, and it does make quite a lot of sense. It seems as if the vast majority of American doctors don’t understand how to properly treat Hypothyroidism… all my doctor does is make sure my TSH is suppressed and I’m considered “controlled.”
Do you have pain liver? I am hypothyroid since 2018 and tried many times with levothyroxine and synthroid and I can tell you that synthroid is much better. However it will give you a good TSH range and free T4 range but free T3 will be low  every time. In 2020 I tried taking Armour thyroid and for 6 weeks I felt fantastic because in addition of my free t4(1.5) i was getting good amount of free t3 from armour (60 mg of armour) and after those 6 weeks, I become hypothyroid for the next 4 months because the doctor did not know how to adjust the dosage and I was getting high level of free t3 and my free t4 was bottom., 0.89.This is the time when i started experience liver/gallbladder pain from time to time, however my liver enzymes were always in range. I was switched back on synthroid and I felt good for 3-4 moths and then my free t3 decreased again and felt hypo again.

Recently, I asked a naturist doctor from Wisconsin to help me with dosage on armour and synthroid and I feel I am on the right track. You just have to try to see which med is the best for you.

What i noticed.... if you eat too many carbs your liver can not make the conversion from t4 and t3 ....you might even have a insulin resistance.... those high lever enzymes are not a good sign for sure.
If I was in your place I would do "no bad carbs" diet for a month and see how your body react to that. Just veggies and good quality meat and some nuts.
This is just my experience and I hope that will help you .
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