You presented a case study in impaired liver function unit, my opinion looking on the lab test is possible thyroid dysfunction. Why not look at thyroid antibodies or the gut? Here’s the extract on the lab test you present: TSH 1.95, T4 of 5.3, T3 of 91, T3 uptake 26. Here’s the description of the case study. The next patient is 26-year-old female with a chief complaint of GI issues, anxiety, panic attacks, hair loss, fatigue, lethargy, hypertension, acne, dry skin, and eczema. These issues began after travel in Thailand for four years prior to coming in to see me. ALT, AST, LDH, BUN, and creatinine are all lab high, and alkaline phosphatase and GGT are low normal. We ran LDA, isoenzymes, and her LDH was normal this time at 165, but she had slightly low fraction #2, which is not clinically significant. None of the fractions were elevated. Testing is ongoing in this patient. It’s not yet clear what’s causing her elevated AST and ALT. We ruled out most of the causes that are listed in the algorithm back there, but we’re working on addressing some other underlying issues that she has, and then our plan is to retest and see if they have gone down.

I can’t remember exactly, but I think the case in this patient was after we addressed her GI issues, her ALT and AST dropped down to normal, and her thyroid markers improved.

Thyroid issues can sometimes cause elevations in aminotransferases, and sometimes it is useful to address that primarily. But in many cases, when thyroid markers are just slightly out of range as they are—I mean they’re not even really technically out of range here, but I don’t remember if we provided the free T4 and free T3 levels, but if her TSH is below 2 and her free T3 is above 2.5, then I wouldn’t really consider that to be a thyroid issue. Even if the free T3 is a little low, if we look at thyroid problems from a functional perspective, as you know in many cases that thyroid is not necessarily the underlying problem, even if the thyroid markers are off. That’s especially true if TSH and T4 are normal and T3 is low. In that situation, as you know, that can be related to inflammation reducing the conversion of T4 to T3 or GI issue reducing the conversion of T4 to T3, and in many of those cases, it’s more effective to address those underlying issues first to see what happens with the thyroid panel instead of going in with replacement thyroid hormone or even necessarily AIP or specific steps to address autoimmune pathology because sometimes that will resolve when you address the thing that is dysregulating the immune system in the first place, assuming that thyroid antibodies were present with this patient, which I don’t think that they were. We do run thyroid antibodies on every patient at this point. That case study might have been older from when we were only running thyroid antibodies as a follow-up after the case review, but at this point, we run them with every new patient. You’ll see that reflected in the case review blood panel.