[Bobbi]

#1064637

When you have elevated liver enzymes it means that there is inflammation or damage to cells in the liver. This is due to the fact that inflamed or injured cells leak higher than normal amounts of certain chemicals, including liver enzymes, into the bloodstream, resulting in elevated liver enzymes on blood tests.

There can be a variety of reasons for elevated liver enzymes to occur. Sometimes it is an indication of some type of chronic condition. But, when we are on drugs that are metabolized in the liver — like methimazole — it is important to rule the drug out as a cause. When a drug is metabolized in the liver, it is changed into other compounds , some of which are used in the body while others are waste products. The liver is an organ which helps to eliminate waste products from the body (kidneys also), but sometimes the waste products of a drug’s metabolization are toxic and can damage the liver unless it can get rid of them quickly.

Sometimes the problem is not just a single drug, but a variety of them, taken together that puts pressure on the liver cells. It might be helpful if you consume any alcohol, for example, to eliminate it while you are on methimazole. Tylenol is known to cause liver problems, especially when taken with alcohol, so I would suspect that it is something that might be avoidable while taking methimazole, too. Two examples, but there are probably lots of others. You might want to brainstorm with your doctor about anything else you might be taking that could be contributing to the problem.

If it turns out that it’s likely the methimazole is the problem, typically stopping the drug helps the liver to recover.

[snelsen]

#1064638

Hi. I thought of a few things for you to think about, but Bobbi covered most of them very well.
I am wondering if you have been on a blood pressure med prior to all of this, or if the endo prescribed it as one of your three meds for being hyper. Also wanted to mention to you that from what you wrote, your fainted because your BP got too low?
Another reason for low BP, especially when you are on new anti-hypertensive meds, is to remember to drink water. It is possible to have low blood pressure, even faint, if you are "volume depleted," ie, there so too fluid in your blood volume.
If high blood pressure is something you have had before the Grave’s, there are lots of different BP meds, and sometimes the prescribed amount needs to be decreased if you go in the basement with your BP.

If your liver enzymes continue to soar, your endo might take you off meth. I know you mentioned you had read a lot of concerning things about PTU, I just want to say that I was on only PTU, got along fine. It is good that there are two drug choices, both have their issues, but both are anti-thyroid drugs. The important thing is to get out of that hyper state!
Sounds like you are getting good care. Shirley

[Mish5572]

#1018415

Hi everyone. Well I just got back from seeing my Endo for the second time last week after fainting again yesterday. He took me off of my blood pressure medication and increased my Propanalol. He thinks that will take care of the fainting issues…let’s pray. Now there is a new complication. Based on the labs done on Monday, my liver enzymes are through he roof (not to sound dumb, but what exactly does that mean?). So he has lowered my dosage of Methimazole to see if this helps. He doesn’t want to take me off completely because my thyroid levels, though coming down, are still high. Has anyone else experienced this on Methimazole? I searched the boards and found plenty of issues with PTU, but not so much with Methimazole. I go back in 4 weeks for more blood work. What will happen if my liver enzymes are still high?

[Kimberly]

#1064639

Mish5572 – Bobbi has provided you with some great info. I don’t know if there is a medical cause for this, but I also wanted to add that I have heard several stories from patients who were hypER and had elevated liver enzymes *before* starting treatment. Then the liver issues calmed down as their thyroid levels dropped back into the normal range.

Was this the first time you’ve had liver enzymes tested? It’s common for patients to get a baseline test done before starting meds as a baseline to see if things get *worse* after the meds are started. Either way, it’s good that your doc is staying on top of this. Liver issues caused by anti-thyroid drugs are fortunately very rare, but this is definitely something to pay attention to — and switch treatment options if needed.

[Lauri]

#1064640

I use MedHelp to track the mediations/symptoms I am on, and to see if there are various effects…One thing I used to dois take lots of Ibuprofen/Motrin for joint aches and pains…THIS IS A NO-NO for people taking beta blockers as it will cause liver malfunction. Please advise everyone to READ the pamphlets that come with the prescriptions. Over the past 2 days I have read so many inquiries about side effects it is not funny…All this should be listed in the pamphlets, if not, a simple web query of the name of the medicine will produce the information. Also, very important to know…people who take Blood thinners SHOULD NOT take MMI…people on MMI can not take Clozapine!

http://www.medhelp.org/druginteractions

this is a good place to start…also Yahoo has one. http://www.drugs.com/drug_interactions.php

My Medication Record, by Drugs.com is an app you can put right on your My Yahoo page. this is what it says:

atenolol ⇔ ibuprofen
Applies to: atenolol, ibuprofen

Moderate Drug Interaction

MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effect of beta-blockers. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis, which results in unopposed pressor activity producing hypertension. In addition, NSAIDs can cause fluid retention, which also affects blood pressure. Indomethacin and piroxicam have been reported to have greater attenuating effects than other NSAIDs, and indomethacin effects may be significant in patients with eclampsia.

MANAGEMENT: Patients receiving a beta-blocker who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation, discontinuation, or change of dosage of the NSAID. The interaction is not expected to occur with low doses (e.g., low-dose aspirin) or intermittent short-term administration of NSAIDs.

Read more: http://www.drugs.com/yap/check.php?id=4 … z0vBOMZSYU

I hope all this helps some…

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