Question: I am a 29 year old XXXXXXX Male (Married). Height: 5 feet 8 inches Weight: 71 kgs.

I have been a moderate smoker all my adult life (since I was 18) I usually smoked 4-5 cigarettes a day. I have been underweight all my life till I turned 24, after which I started gaining weight due to lack of exercise and alcohol consumption.
When I turned 26 I was diagnosed with anxiety disorder for which I was put on SSRIs (stalopam 10 mg to start with, which was cut down to 5 mg daily). I am now on a dosage of 1.25 mg per day (i take 2.5 mg every alternate day). At the time of the anxiety disorder diagnosis my blood pressure was also high and i was put on Stamlo 2.5 mg daily. TSH, T3 & T4 were normal.
My alcohol consumption increased after I got the anxiety disorder. By the time I turned 27 (two years back) my weight increased to 80 kgs and I decided to start exercising and also got some blood tests done for fasting lipids and sugar. Lipids were quite high and HBa1c was 6.4. HDL was a little low (39). My blood pressure was also high despite being on 2.5mg Stamlo. BP medication was increased to Stamlo 5 mg per day. TMT and 2D echo for the heart was normal. I was put on a low calorie, high fibre diet and was told to exercise regularly. Liver function tests were also done and mild elevation was found in liver enzymes. Abdomen ultrasound was normal for all organs except for mild fatty changes on the liver. I was told to stay off alcohol for 6 weeks. I did so. All this while I was still smoking.

After a few months on the controlled diet my lipids started to normalize and HBa1c came down to 5.9. My BP was also under good control. The anxiety medication were also working well and I cut down dosage of SSRI to 2.5 mg a day.
After I got well, my alcohol consumption increased to 4-5 large drinks 3 days a week. I however, kept exercising regularly and also controlled my diet (high fibre), due to which my weight was always between 72-74 kgs and HBa1c was also stable at 5.9 and BP was also never above 130/90. TSH, T3 and T4 were normal as well.
About an year back when I got my blood work done, I found triglycerides to be quite high and Liver Function Tests also showed high. Vitamin D was very low at 5. Vitamin B12 was low too.
Lipid Profile Results:
Triglycerides: 274
LDL: 155
HDL: 23
Liver Function Tests:
AST: 71
ALT: 299
ALP: 173
GGT: 103

I saw both a cardiologist and a hepatologist. I was prescribed liver support medication and a statin.
Liver Support Medication:
Alcoliv (once a day)
Heptal 400 mg (twice a day)
Solubid 300 mg (twice a day)
Vitamin B12 (twice a day).

I was given Vitamin B12 shots as well. I was told to stop alcohol completely. The Hepatologist told me that I have alcoholic hepatitis. My liver was palpable and firm. I stopped alcohol completely and I have been alcohol free since then (last 9 months). I was also counselled by the cardiologist to stop smoking. I didn’t stop smoking at that time. My liver function tests came back to normal in a month and Triglycerides came down to 120 and LDL came down to 70. HDL however did not increase and stayed close to 25. HBAc1 was 5.8. Alcoliv and B12 were stopped. I continued to exercise all this while and kept taking a high fiber diet (2 bowls of salad a day, sprouts, no fat, etc). I started to play cricket early morning, 6 days a week. The liver is still palpable but not as firm any more. A recent ultrasound still suggests hepatitis with Grade 1 fatty changes. My blood pressure started decreasing so I am off BP medication now.

The cardologist continued to suggest that if I quit smoking my HDL will increase. I quit completely for a month. After a month when I got my Lipids tested, the HDL had reduced to 19, the triglycerides and LDL had increased. This was puzzling. No TSH or LFT was tested. Doctor and I thought that it was due to the increased appetite. After a month I got back to smoking due to some work related stress.

3 months ago on 25th December 2014, while playing a cricket match I broke my thumb. It was a fracture Since, fractures take longer to heal for smokers I had my last cigarette and said good bye to smoking. I have been smoke free since then. It been more than 3 months now. The craving stopped mostly after 2 weeks and after a month I was totally craving free. During the first month I felt better as well. On 17th January 2015 I got an LFT and Lipid profile done again due to some mild nausea. My triglycerides had shot up again to 177 and LDL also increased from 70 to 112. HDL was 26 (no increase). I am guessing that due to increase in triglycerides the LFT’s also increased marginally. ALT increased from 47 (on 27 Sep 2014) to 69. Due to the broken thumb I had stopped exercising Hepatologist told me to increase the dosage of Statin from 5 mg to 10 mg daily. I did so and as a result all in 15 days tests normalized except for HDL which decreased from 26 to 19. Due to the decrease in HDL i was advised to take 10 mg statin on alternate days. I did so and my LIPIDS and LFT’s remained normal. I started exercise again. I also reduced the dosage of the SSRI from 2.5 mg daily to 2.5 mg on alternate days.

Around mid Feb 2015 I got the first allergic reaction of my life. I had extremely itchy skin, red patches on hands, legs, neck, swollen eyes. I have no known allergies. I had mushrooms on the night before the allergy started, but i have had mushrooms for a long time without any allergy. Food allergy panel tests showed nothing. I was given Anti-histamines and steroids for 10 days. I couldn’t exercise for these 10 days and my appetite increased as well. My weight increased from 69 to 74 in a month. With exercise I have reduced the weight back to 71 now.

I got fresh Lipids, LFTs and Thyroid Function test done a couple of days back and for the first time in my life the Thyroid function tests indicate hypothyroidism. I have a family history of diabetes (mother’s siblings), high blood pressure (mother) and hypothyroidism (mother).
I am feeling a little down (maybe depressed) these days and have mild nausea too for a couple of seconds every now and then. Ever since i quit smoking my abdomen is always hard, gassy and bloated. I have regular stool movements as soon as I wake up every morning (around 5 am), but by the evening it gets gassy and bloated again. I feel energetic when I play (about 2 hours everyday) but after that I don’t feel too energetic throughout the day. Cricket also give me a lot of muscle, shin, ankle and heel pain. Days come and go and I feel kind of numb. I love playing cricket and that is the only thing I look forward to. Libido is also a little low. I have no pain or swelling in the throat.

Here is the present picture.

TSH:               7.07
Total T4:           4.40
Total T3:          89.09

Fasting Lipids:
CHOLESTEROL 138
TRIGLYCERIDES 93
CHOLESTEROL HDL 25
DIRECT LDL CHOLESTEROL 90

GLYCOSYLATED HEMOGLOBIN (HBA1C) 5.8

Liver Function
GAMMA GLUTAMYL TRANSFERASE (GGT) 32
BILIRUBIN, TOTAL 0.57
ALANINE AMINOTRANSFERASE (SGPT) 41
ASPARTATE AMINOTRANSFERASE(SGOT) 19

Vitamin D     27.16
Vitamin B12     534.0

Here is a list of medication I am on now:

Heptral 400 mg (twice a day)
Solubid 300 mg (twice a day)
Rheovit (once a day)
Stalopam 2.5 mg (alternate days)
Rosuvas 10 mg (alternate days)

BP:
120/80 in the morning
130/90 in the evening

There is a strong correlation between smoking cessation and hypothyroidism.
Do you think I have hypothyroidism or Hashimoto’s disease?
If No, what other tests do I need for a confirmed diagnosis

If Yes
Do you think I had hypothyroidism all this while but smoking was masking it? The high cholesterol and weight gain could have been triggered by hypothyroidism right from the beginning. I have peers who drink and smoke and eat everything and don’t exercise and they don’t gain weight or have high cholesterol. I gain weight quite fast if I stop exercising.

Could the hypothyroidism be triggered by the existing hepatitis of the liver?

I have never had an allergy before and I hear allergies show up with Hashimoto’s. Are the two related?

Are there liver friendly medications available for Hypothyroidism or should I look at natural alternatives in Ayurvedic medicines and Yoga (i already do some basic breathing exercises since the past 4 years).

What should I do now?

Thanks for going through the detailed history. I have some more clarifications and some more questions.

I have always done the lipid profile tests after a 12 hour overnight fast. We can trust the results. I am quite certain that my lipids go up after I quit smoking.

The main problem that I face these days is muscle pain from fast bowling. I have been practicing in the nets 5 days a week since the last 6 months. I have had shin bone pain on and off but muscle pain in the legs and shoulder, is new. I also have ankle soreness and pain throughout the day. I get pain in the calf and hamstring too. I hear the hypothyroidism causes muscle wasting and increases likelihood of injury amongst athletes. I am playing serious cricket these days (league/club cricket and corporate cricket) and I bowl everyday in the nets despite the pain. I want to know if I am risking a major injury. Should be get the opinion of an endocrinologist on this forum?