Blood analysis for thyroid, liver and kidneys

Blood tests can measure:

• the hormones of the thyroid gland
• the enzymes of the liver, such as bilirubin and albumin (a protein produced in the liver)
• Excretory products of the kidney

These values are used to test the functioning of these organs.

You do not have to be fasting for the examinations of the thyroid gland and kidneys, and you can always drink water and coffee.
Before examining the liver (phosphatase and bilirubin) one must be fasting for 8-12 hours.

Blood analysis for the thyroid gland

An examination of the thyroid gland is prescribed if the patient suffers from:

• Fatigue
• Increase or decrease in body weight
• Nervousness
• Hyperactivity
• Insomnia
• Intolerance to heat or cold
• Skin dryness
• Irregular menstrual cycle
• Protruding eyes
• Goiter (a swelling at the front of the neck)

Normal values

• Stimulating hormones (TSH) from 0.3 to 5.6 μU/ml
• Thyroxine T4 – from 4.5 to 12.5
• Free thyroxine fT4 – from 0.7 to 2.0
• Total triiodothyronine T3 – from 80 to 220
• Free triiodothyronine fT3 – from 2.3 to 4.2

TSH or thyroid stimulating hormone

If the TSH value is below the lower limit:

• and the levels of T3 and T4 are normal, the patient suffers from mild or subclinical hyperthyroidism
• with elevated T3 and T4 levels, you may have too active a thyroid gland or hyperthyroidism

If the TSH value is above the normal value:

• and the levels of T3 and T4 are normal, the patient has mild or subclinical hypothyroidism
• with decreased T3 and T4 levels you can have hypothyroidism

In both cases, the doctor may prescribe a suitable medication.

Thyroid antibodies

The microsomal antibodies are also called antiperoxidase (or anti-TOP).
These values are also high in autoimmune diseases of the thyroid gland:

• Thyroiditis according to Hashimoto
• Graves’ disease

Thyroglobulin antibodies are increased in:

• Autoimmune thyroiditis
• other non-thyroid autoimmune diseases

It is more likely to be suffering from thyroiditis according to Hashimoto (60% of patients) than from a disease according to Graves (30%).
This examination is often done on patients with thyroid cancer.

Blood analysis for the liver

These are examinations designed to find out whether the patient has a disease of the liver or bile ducts if he has the following symptoms:

1. Jaundice
2. Bloated belly
3. Vomit
4. Nausea
5. Stomach ache
6. Right-sided flank pain
7. Dark discoloration of urine
8. General malaise
9. Fatigue
10. Skin itching

Transaminases (ALT and AST)

Transaminases are enzymes that undergo some chemical reactions with amino acids.
In the case of liver damage, the analyzes show an increased value.
The transaminases are divided into:

1.ALT or GPT (alanine aminotransferase)

Normal values: 8 to 37 U/l for women and up to 50 U/l for men.
This test examines the liver’s ALT enzyme levels.
Alanine aminotransferase is:

• mostly concentrated in the liver
• present to a lesser extent in the heart and skeletal muscles

In the case of liver damage, the liver secretes this enzyme into the blood. ALT is the enzyme best used to determine whether a person has a disease or a problem with the liver, AST is less specific and could still have normal values.
A sharp increase in this enzyme may indicate that:

• very high ALT
  • Liver problems such as acute hepatitis
  • Tumor necrosis in liver cancer or metastases leading to a very high ALT
  • Hepatitis due to abuse of alcohol
• moderately high ALT
  • Muscle injuries or very heavy exercise
  • Heart attack
  • Lead poisoning
  • some medications such as statins, antibiotics, chemotherapy, aspirin, narcotics and tranquilizers
  • Mononucleosis
  • chronic hepatitis B or C
  • Lack of blood circulation in the liver
  • Hemochromatosis, a disorder that leads to deposits of iron in the body
  • Pancreatitis, an inflammation of the pancreas
  • Fatty liver
• slightly increased ALT
  • In children, rapid bone growth can lead to a slight increase in ALT.

The values may be influenced by:

• some herbs, for example valerian and echinacea
• a previous cardiac surgery

2. AST or GOT (aspartate aminotransferase)

Normal values:

• 10-34 rpm for women
• up to 45 U/l for men

This enzyme is found in the tissues of the heart and liver. Thus, increased AST indicates problems that occur in one or both organs.

Elevated AST levels may be caused by:

• Liver damage caused by hepatitis or cirrhosis
• Heart attack
• Heart failure
• some medications such as statins, antibiotics, chemotherapy drugs, aspirin, narcotics and tranquilizers
• intense exercise or severe muscle injuries
• high doses of vitamin A
• Damage to kidneys or lungs
• Mononucleosis
• some cancers

Screening for AST is specifically designed to determine whether the person has alcoholic hepatitis.
A lowered GOT is not a cause for concern.

Alkaline phosphatase (ALP)

Phosphatases are enzymes that intervene in the cleavage of phosphate groups, namely in dephosphorylation.
These are chemical reactions that take place in the organism.
Phosphatases are mainly found in the cells of:

• Liver
• Bone

In the area of the liver, they are mainly found on the walls of the cells that form the bile ducts, i.e. the channels that serve to transport bile from the liver to the intestine.
The bile serves the digestion of fats.
With a narrowing of the hepatic ducts, the increase in values is considerable, up to 10 or 20 times higher than normal.

In the area of the bones, the formation takes place by osteoblasts, i.e. cells that form the bone tissue.

• Bone diseases cause a slight increase in phosphatase
• Liver diseases and blockages of the bile ducts cause a very sharp increase in the levels of this enzyme

To determine whether the cause of increased phosphatase lies in liver damage, the doctor also examines the values of:

• Bilirubin
• Transaminases (AST, ALT)

Normal values: 44 to 147 IU/l

The values are increased:

• in children, because the bones are growing
• in women during pregnancy
• for bone disorders, such as: osteomalacia, Paget’s disease, a bone tumor
• in liver diseases: cholestatic hepatitis, cirrhosis, abscess, liver cancer or metastases
• for gallstones
• if a tumor narrows the bile ducts (for example, on the head of the pancreas)
• in case of infection with cytomegalovirus or infectious mononucleosis

A decreased alkaline phosphatase generally has no meaning, it can occur due to:

• a blood transfusion
• a coronary bypass
• Zinc deficiency
• Malnutrition (for example, caused by celiac disease)

Gamma-GT

Gamma-GT is an enzyme used to transport amino acids through the cell membrane.
It is mainly found in the membranes of the liver, bile ducts and kidneys, but the levels of this enzyme in the blood depend mainly on the health of the following organs:

• Liver
• Bile ducts

An important feature is the extreme sensitivity of this enzyme, because in fact the values increase even before the onset of the symptoms of the disease.

Normal values

• in men under 55 U/l,
• for women under 38 U/l

Increased gamma GT values
The values are very high in case of narrowing of the bile ducts (intra- or posthepatic).
They reach about 5-30 times higher values than normal.
With occlusive jaundice, cholangitis and cholecystitis:

• gamma-GT is increased before alkaline phosphatase, AST and ALT
• if the increase persists over a longer period of time

Elevated levels of gamma-GT may be caused by:

• Hepatitis, the increase is less, about 2-5 times the normal
• primary and secondary (metastatic) neoplasia
• alcohol-related cirrhosis
• excessive alcohol consumption
• Taking medications such as phenytoin and phenobarbital

Interpretation of blood analysis for the liver – data combinations

In a healthy liver, the GGT levels do not exceed 45. If the GGT increases to over 100, the doctor examines the levels of the other liver enzymes to determine the cause of the disorder.

Note: In some people, it is normal for the GGT to be higher than 120 without the liver having problems.

If the GGT is > 100

1) When ALT and ALP are normal

Possible causes:

• alcoholic beverages
• Drugs such as heroin
• Diabetes
• Fatty liver
• increased triglycerides
• Taking medications such as: barbiturates, benzodiazepines, anticonvulsants, warfarin, tricyclic antidepressants, paracetamol, painkillers or immunosuppressants

2) When ALT is normal and ALP is elevated

Possible causes:

• the flow of bile is disturbed or interrupted, for example:
  • Gallstones
  • Hepatitis
  • Tumor pressing on the bile ducts
• Medication or alcohol abuse, which can slow the flow of bile
• Cirrhosis
• liver disease or bone problems, as the level of the enzyme ALP also increases in bone diseases

3) When ALT is raised and ALP is decreased

Possible causes

• Viral infection: hepatitis A, B or C or mononucleosis
• Drugs
• Alcohol
• Fatty liver

4) When ALT and ALP are elevated

This situation occurs with liver damage and slowed bile flow, for example:

• acute hepatitis caused by:
  • Virus infections
  • Medication
  • Alcohol
• chronic hepatitis
• Tumor that hinders the flow of bile (for example, in the liver or pancreas)
• Cirrhosis

In alcoholic fatty liver, the liver enzyme AST is greatly increased.

Bilirubin

Normal values: 0.1 to 1.9 mg/dl
It is a pigment (of brown-yellow color) in bile, a digestive fluid produced in the liver.
Bilirubin is produced when the hemoglobin is broken down in old red blood cells.
The destruction of old cells is a physiological process.
After the bilirubin circulates in the blood, it passes to the liver.

In the liver, bilirubin will:

• conjugated
• mixed with bile
• excreted via the bile ducts

From here it migrates into the gallbladder, which forms a temporary depot.
In the end, the bile is released into the small intestine to serve fat digestion.

There are two types of bilirubin:

• bilirubin, which is not bound to glucuronic acid and is called indirect or non-conjugated bilirubin
• bilirubin, which is bound to glucuronic acid and is called direct or conjugated bilirubin

The sum of these two species is total bilirubin.
Sometimes the liver cannot metabolize this fluid due to:

• excessive production
• Obstruction of the bile ducts
• Inflammation of the liver

Excessive, non-conjugated bilirubin may be caused by:

• Neonatal jaundice
• Hemolytic anemia or pernicious anemia
• Transfusion
• Cirrhosis
• Gilbert’s syndrome, a common metabolic disorder caused by the lack of the enzyme that binds the sugar molecules to bilirubin
• heavy physical activity
• improper diet

If the conjugated bilirubin is higher than the non-conjugated (indirect), the causes may be:

• Viral hepatitis
• Alcohol-induced hepatitis
• Drug response
• Bile duct concrements
• Bile duct damage
• Tumour

Lowered values need not worry.

Albumin

This is the most important and most common blood protein.
Albumin is produced in the liver and has many functions, mainly:

• Transport of substances
• Maintenance of oncotic pressure in the blood

Elevated albumin levels may be caused by:

• Dehydration
• severe vomiting

Decreased albumin levels may be caused by:

• rapid hydration (hyperhydration)
• Malnutrition
• Liver diseases (viral hepatitis, severe cirrhosis)
• Kidney disease (nephrotic syndrome)
• severe burns
• Pregnancy
• Use of oral contraceptives

Blood analysis for the kidney

Kidney disease causes no symptoms until the advanced phase.
Blood tests for the kidney are indicated for:

• Pain and difficulty urinating
• Urinary opacity
• Change in the amount of urine produced
• Blood in the urine

Ein Risiko für Nierenprobleme besteht bei Menschen mit:

• Diabetes
• Bluthochdruck
• Herzinsuffizienz
• Krankheiten, die über längere Zeit mit nierentoxischen Medikamenten behandelt werden (zum Beispiel nichtsteroidale Entzündungshemmer, Chemotherapie usw.)

Stickstoff oder Harnstoff

Nitrogen (or urea) is the value that indicates the amount of non-protein nitrogen in the blood.
Normal values: 10 to 20 mg/dl
This is a measurement for functional testing:

• of the kidney
• of the liver
• of the heart

High nitrogen levels
Reasons for this can be:

• Kidney diseases:
  • Polycystic kidneys
  • Acute glomerulonephritis
  • Chronic nephritis
  • Nephrosclerosis
  • Necrosis of the renal tubules (damage to the renal tubules)
• Diabetes
• Hypertension
• circulatory disorders of the kidneys caused by dehydration or heart failure
• High-protein diet (with too much protein)
• Addison’s disease
• Tissue damage (as in severe burns)
• Gastrointestinal bleeding

Decreased values
A decreased nitrogen level can be caused by:

• a very low-protein diet
• Malnutrition
• serious liver damage
• Drinking excessive amounts of fluid

Creatinine

Normal values:

• 0.5 to 1.1 mg/dl in women
• 0.6-1.2 mg/dl in men (older people may have a slightly decreased value)

In infants, the values are about 0.2 higher.

The kidneys excrete the waste products of the muscles, so elevated creatinine levels could indicate renal dysfunction.

Diseases that cause increased creatinine include:

• Diabetes
• Hypertension
• Rheumatoid arthritis
• Gout
• Systemic lupus erythematosus
• Endocarditis
• Compensated heart failure
• Glomerulonephritis
• Nephritis
• Pyelonephritis
• Renal failure
• Narrowing of the urinary tract
• Multiple myeloma
• Shock
• Uremia
• Hyperthyroidism

The causes also include some drugs such as: chemotherapy drugs, antibiotics, diuretics, etc.

Decreased creatinine may be caused by:

• Pregnancy
• Reduction or loss of muscle mass
• Infections
• Cirrhosis
• Tumors
• Heart failure
• protein-rich diet

Urea/creatinine
ratio Normal range: 10:1 to 20:1 (men and the elderly may have a slightly increased value).
This test indicates whether the kidneys are correctly excreting the urinary substances.

• Causes of jaundice – bilirubin and hepatitis
• Causes of jaundice: bilirubin and hepatitis
• Infectious and primary sclerosing cholangitis