Brief Answer:
Liver function tests, hypothyroidism, anemia.

Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.

Based on your query, my opinion is as follows:

1. Yes, your blood ammonia level is mildly raised.

2. Ammonia is a byproduct of protein metabolism, so more protein means more ammonia. Mostly ammonia is made in gut by bacteria, which gets absorbed and gets converted to urea in liver. In liver abnormalities, ammonia can raise.

3. Your increased protein intake could have contributed to presently increased ammonia. Cigarette smoking, alcohol and muscular exertion can increase ammonia.

4. You sleep quality is good in my opinion, but more information on your sleep habits would be helpful.

5. Daytime sleepiness, unable to focus and drowsiness could be symptoms of hypothyroidism or anemia.

6. For liver specifically you can get a "liver function test" done (its a panel of tests). Additionally, also get a complete hemogram and a thyroid hormone profile done.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

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Brief Answer:
Sleep study if liver normal.

Detailed Answer:
Hi,
Thanks for asking again.

Hopefully, your thyroid tests and hemoglobin levels are normal. If not, will require correction.

Reduction of ammonia is only possible through proper liver function. Liver function test could help in confirmation.

Two years is a long time. Have you been evaluated for
1. Obstructive sleep apnea syndrome - A sleep study can confirm whether you night sleep was normal, adequate or abnormal and disturbed.
2. Any stress, depression or anxiety, which could lead to disturbed sleep.
3. Working in shifts could affect

If the liver function tests are normal, You can cut down on protein and see if it improves you.

If not, you could meet a neurologist or psychiatrist to get a sleep study done. Obstructive sleep apnea syndrome is easily treatable.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

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Brief Answer:
Subclinical hypothyroidism

Detailed Answer:
Hi,
Thanks for sending the reports.

Based on your reports, my opinion is as follows:

1. Subclinical hypothyroidism - Your TSH is high indicating a possible reducing Thyroid hormone levels in future. You can repeat the test after 6-8 weeks and if TSH is high, you will require to be started on thyroid hormone therapy.

2. Eosinophilia - You are possibly allergic or you had a recent cold. Worm infestation can also cause eosinophilia. Albendazole, once now and one, one week later should solve worm problems. If you have cold, sneezing, you need to look into allergens.

3. Mildly increased ammonia - not to worry. With normal ESR, i do not expect your liver function tests to be abnormal.

Look into protein reduction, which will definitely reduce your ammonia. But, I am not sure, it will reduce daytime drowsiness etc. Nothing wrong in giving a try.

If you thyroid correction does not work, you will require a sleep study to rule out sleep apnea syndrome.

Otherwise, all other things are perfect.

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Brief Answer:
Specifically ALT & AST enzymes

Detailed Answer:
Hi,
Thanks for asking again.

1. For liver functions - You can get a complete "liver function test" done - or ALT and AST level estimation done.

2. After 6-8 weeks repeat thyroid profile to recheck TSH level.

3. Repeat blood counts for eosinophil after a month, once you rule out any possible allergic cause or worm infestation in gut.

Other tests will depend on these tests.

Liver function tests - forms a panel study. You can get all the tests done or specifically "ALT and AST enzymes" to evaluate for possible liver damage.

Hope it helps.
Any further queries, happy to help again.

Dr. Jyothi BL

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