[JeremyM]

#1060379

hello, I’m new here and looking for some answers.

I was recently diagnosed just over 3 weeks ago with graves disease.

My labs:

T4 – normal range (11.5 – 22.7), results – > 77.2
T3 – normal range (2.30 – 6.30), results – > 30.7
TSH – normal range (0.400 – 4.00), results – > 0.006

I was prescribed 10mg metizol 3 X per day.
Prior to taking the medication my liver enzymes were not taken.

2 weeks after taking metizol a liver enzyme test was performed and the results were very high:

AST – normal range (0 – 40 U/L), results – > 171,24
ALT – normal range (0 – 40 U/L), results – > 452,49

My thyroid levels were taken again yesterday and though i have made a great improvement physically, feeling normal again my thyroid levels were still deemed to high to come off metizol, being prescribed 5mg per day.

Is it normal with liver enzymes that high to still remain on a small dosage of metizol?

I understand that the cause of the high enzymes still has to be determined and that there’s a possibility there could be other factors affecting the result other than just the drug. Though this could have been already determined if not for the negligence of the doctor having not performed a liver enzyme test prior to prescribing a potentially liver damaging medication(well that’s my opinion, maybe I’m wrong).

I’m looking for advice if i should still be taking the 5mg of metizol after my liver enzymes were so bad, consequences of stopping metizol immediately after having such a high dose and the rate at which my thyroid levels might increase?

I decided(though unsure) not to take any metizol until i can get additional blood work myself this week (enzymes, thyroid hormones) to look for a drop in enzymes and check the pace at which my thyroid levels increase without taking medication to try and determine the efficacy of metizol for me and its potential consequences to my liver.

Maybe im going about this the wrong way. All advice is welcome.

Thanks,
Jeremy

[Kimberly]

#1182311

Hello and welcome – We are fellow patients here, not doctors, so we are not allowed to give medical advice. This is certainly a difficult situation, where you need to balance the risk of liver complications versus the risk of going off the meds for hyperthyroidism.

Elevated liver enzymes can be a side effect of the meds, but they can also be associated with hyperthyroidism itself – which is why as you noted, the latest medical guidance recommends that doctors run a baseline liver function test prior to prescribing Anti-Thyroid Drugs.

You definitely need a doctor’s guidance as to whether the safer course is to stop or continue with the meds. What does your current endo say? And if you can’t get a response there, can your primary care doc give you some advice? Also, keep in mind that for those of us with Graves’, our relationship with our endo is a fairly long-term one, so if you don’t have confidence in the doctor you are currently seeing, you might consider getting a second opinion.

Take care – and please keep us posted!

[adenure]

#1182312

Hi Jeremy,

I had a similar situation. I was taking 5 mg of methimazole once a day, and my liver enzymes escalated to 8 times the normal range from the start of taking the medication to 7 weeks into it (I didn’t get labs earlier). I had labs done before starting methimazole, and my liver enzymes were completely normal. So, when I got the lab results back with the very high liver enzyme reading, the on call doctor told me to stop the methimazole immediately. He had me come in and get liver labs 3 days after stopping to make sure the enzymes were coming back down (which they were, but not totally back to normal at that point). My doctor also had me have an abdominal ultrasound to check my liver and make sure everything was okay (once my enzymes were back to normal). Everything was fine, and I didn’t have any irreversible damage.

So… that left me in a bit of a pickle! I couldn’t take methimazole and PTU was not recommended. Fortunately, in those 7 weeks, my thyroid levels returned to normal. So, 6 weeks later I had my thyroid removed surgically. By the grace of God I somehow managed to keep my thyroid levels stable those 6 weeks I was waiting for surgery, but I was an emotional wreck- worried silly that I would go hyperthyroid again. Actually, the week before surgery, I could feel the anxiety and heart rate creeping up again, but that could’ve been anxiety due to the surgery! At any rate, I had the surgery and am so glad that I did! In an odd way, not being able to take anti- thyroid drugs was a blessing. It forced me to make a choice and be able to move forward with my life. Finding the dose for Synthroid takes some time and patience, but I believe it is easier for our bodies to handle and also once you find that right dose, in general, it stays the same I think- more or less.

I would ask the doctor about what his suggestion is for your next step in treatment. I am really happy that I chose surgery, but I know others are happy with RAI. It is ideal to have your thyroid levels normal before either surgery or RAI, but I know people who were unable to achieve that and had surgery anyway (a personal friend). She had a thyroid storm that landed her in the hospital. They put her on betablockers and SSKI drops- she had her surgery a few weeks after she got out of the hospital from the thyroid storm. I know she wasn’t on any anti- thyroid drugs for any length of time to get her levels normal. So, although not necessarily recommended, I know it is done in certain circumstances. I am by no means telling you how to care for your body as I am not a doctor. But- just sharing my own story and that of a friend of mine. Good luck to you.

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