From the Research
Yes, checking thyroid stimulating hormone (TSH) levels is recommended when evaluating patients with transaminitis (elevated liver enzymes). Thyroid dysfunction, particularly hypothyroidism, can cause liver enzyme elevations, with AST and ALT typically rising to 2-3 times the upper limit of normal. The mechanism involves impaired lipid metabolism leading to hepatic steatosis, reduced biliary excretion, and altered membrane permeability in hypothyroidism 1. Hyperthyroidism can also occasionally cause mild transaminitis. When investigating unexplained transaminitis, include TSH in your initial workup alongside other common causes like viral hepatitis, alcohol use, medications, and non-alcoholic fatty liver disease. This is especially important if there are any concurrent symptoms suggesting thyroid dysfunction such as fatigue, weight changes, or temperature intolerance. Early identification of thyroid disease as the cause can prevent unnecessary additional testing, as liver enzymes typically normalize with appropriate thyroid hormone replacement or management of hyperthyroidism.
Key Points to Consider
- Thyroid dysfunction can cause liver enzyme elevations, making it essential to check TSH levels in patients with transaminitis 2.
- Hypothyroidism is more commonly associated with liver enzyme elevations than hyperthyroidism, but both conditions can cause transaminitis 3.
- Checking TSH levels can help identify thyroid disease as the cause of transaminitis, allowing for targeted treatment and preventing unnecessary additional testing 4.
- Other causes of transaminitis, such as viral hepatitis, alcohol use, and non-alcoholic fatty liver disease, should also be considered and evaluated accordingly 5.
Recommendations
- Include TSH in the initial workup for patients with unexplained transaminitis.
- Consider thyroid dysfunction as a potential cause of transaminitis, especially if there are concurrent symptoms suggesting thyroid disease.
- Evaluate other common causes of transaminitis, such as viral hepatitis, alcohol use, and non-alcoholic fatty liver disease, and manage accordingly.