New to liver issues: several questions

[Krystinamarie]

Hello, this might be a little bit of a read but I'm hoping to get an idea of what to expect when I go in to see the gastroenterologist for the first time and what condition I may have that is causing my symptoms.

I'm 22 and I have hashimotos, I went into my PCP concerned that my medication needed to be adjusted as I had been feeling very fatigued, itching excessively, nauseous on an almost constant basis, brain fog/memory issues, anxiety etc. She ran blood work and my thyroid levels were fine but my liver enzymes came back at 57 when they should have been in the 30s. She sent me back to get more in depth testing on my liver. She informed me that it had risen to 157 (4x higher than it should be)  in the two weeks between tests. She also had me tested for autoimmune hepatitis, hepatitis b, a and c all coming back negative. Along with negative for Lupus and Wilson's disease. I was then rushed in to get an ultrasound which came back perfectly normal. I do not drink alcohol and We went over all medications I am taking and she did not think any of them would be affecting my liver especially to this extent, so she put in a referral to Gastro and I've just been waiting to meet with the doctor.

It seems as though symptoms of liver problems can mimic the symptoms of hashimotos or vice versa. But I feel as though over the last few months I have been extremely fatigued and exhausted after even just taking a shower and getting ready. I have problems sleeping at night and I tend to sleep or nap in the afternoon or morning. I've been irritable and anxious and constantly extremely itchy mainly on my legs occasionally on my arms. I've had brain fog and memory issues. I have also been extremely nauseous and Ive also had loss of appetite.

I've looked around on Google trying to learn of possible conditions I could be facing. I was wondering if cirrhosis or hepatic encephalopathy is likely/not likely. Would that have shown up on an ultrasound? I guess I just want to get an idea of what to expect with the appointment and possible scenarios. Is this pretty typical when liver enzymes come back high?

Any info will be appreciated thanks.

[rpwoodard]

Krystinamarie, how are you doing?

[fntn]

As you already know, Hashimotos is an autoimmune thyroid disorder. Your doctor ran a number of blood screens for Wilson's disease, viral hepatitis and autoimmune hepatitis, but did they also run a complete autoimmune antigen profile to screen other AI diseases beyond Lupus? Your ultrasound was normal as well so fortunately your liver doesn't show signs of serious reactions to any insults.

With Hashimoto’s, your liver and thyroid will be interacting with each other via the various hormones (T3,T4,etc). The majority of thyroid hormone is converted from T4 to T3 within the liver, and there are other T3 and T4 metabolic processes as well. This will then affect the synthesis/breakdown/metabolic processing of cholesterol's and other lipids. So the accumulation of the cholesterol's and triglycerides tends to make the bile "sludgy" and slows its transport through the gallbladder and bile ducts, possibly causing stones.

Also, You mentioned that you did have a dark urine episode? This would mean that your bilirubin levels were elevated. Your blood work does show mild elevations in your alkaline phosphatase levels, and this points to your biliary system being stressed by something. If your bilirubin levels were high, then bile could have backed up into the liver, damaging the hepatocytes and raising your Alt, Ast levels.

If your liver is accumulating lipids and developing into fatty liver, then it likely a mild grade since an advanced fatty liver would have been detected via your recent ultrasound test. Keep an eye on the color of your urine. If your do have an obstructed biliary system (sludge or stones), then the directed bilirubin can backup into your blood. This is water soluble so it is excreted via your renal system and high levels will make your urine noticeably darker.

As you've noted, it will be tricky to determine whether or not your other symptoms are do to hepatobiliary issues, or due to your Hashimoto's. Hashimotos will cause many of these by itself: fatigue, brain fog, etc. Just be sure that your doctor keeps regular monitoring of your liver numbers, so you can at least try to correlate things yourself, between your flare and fluctuations.

[Krystinamarie]

We did that with the first test they said it was very dark but I don't have the actual result.

[fntn]

Any Bilirubin numbers?? Urine analysis (Urobilinogen)?

[Krystinamarie]

In case it's helpful I've listed most of the results from the panel they were all normal except

ALK PHOS 159 H (35-105)
AST 121 H (0-32)
ALT 155 H (0-33)

RDW 11.2 L (12.0-16.2)



Wbc 6.6 (3.6-10.6)
Rbc cnt 4.53 (3.7-5.11)
Hgb 13.8 (11.5-15.4)
Hct 42 (35-45.5)
Mcv 92.8 (79.5-96.8)
Mch 30.4 (26.2-33.1)
Mchc 32.8 (32.6-35)
*RDW 11.2 (12.0-16.2)
Plt cnt 211 (162-427)
Mpv 10.6 (7.0-10.9)
Neu% 57.6 (40.7-76.4)
lym% 29.8 (15.9-47.8)
Mon% 7.6 (4.5-11.8)
Eos % 4.2 (0.3-7.1)
Bas% 0.8 (0.2-1.2)
Neu# 3.7 (1.8-7.5)
Lym# 2.0 (1.0-3.1)
Mon# 0.5 (0.2-0.8)
Eos# 0.3 (0.0-0.5)
Bas# 0.1 (0.0-0.1)

NA+ 140 (135-145)
K 4.8 (3.5-5.1)
CL- 102 (98-107)
CO2  23 (22-31)
Glucose 88 (74-106)
Bun 8 (6-20)
Creat 0.7 (0.5-1.1)
CA 9.6 (8.6-10.2)
Protein total 7.1 (6.4-8.3)
Albumin 4.5 (3.5-5.2)
*ALK PHOS 159 (35-105)
*AST 121 (0-32)
*ALT155 (0-33)