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I've been taking Levothyroxine for years due to hypothyroidism caused by radiation from the Chernobyl nuclear explosion and the nuclear cloud that came over Poland. I was hospitalized in 2020 with jaundice and ALT/AST levels of 1756/1217 with Bilirubin of 6.5 and upper right abdominal pain. Previous to 2020, I had no digestive issues or liver problems.
Multiple blood tests, MRIs, and CTs were performed. I will attach some relevant findings from 2020 and current ones. I am a 49 years old otherwise healthy individual with no significant health issues except hypothyroidism.
After five days in the hospital, it was determined that the cause of my problem was a side effect of the birth control pill ( Lo Loestrin ) prescribed to me about twenty days earlier. I was informed that the drug caused jaundice and liver function and gallbladder disturbance.

@loribtm
Fast forward to today, I had a visit with a Gastroenterologist who repeated the blood tests and ordered a transjugular biopsy. I am hesitant about jumping into such an invasive procedure without having an MRI or CT and ruling out an autoimmune disorder. I am thinking about it because of some blood tests and the relatively recent development of bizarre manifestations that may indicate an autoimmune disease that appeared a few months after taking the Covid vaccine ( Raynud's Syndrome, Livedo Reticularis, and random blood vessels bursting and pulling blood under my skin's surface creating bruises not caused by injury or impact ). I also have a family history of autoimmune disorders. My paternal grandmother was diagnosed with connective tissue disorder, possibly Lupus, and my son was diagnosed with Psoriasis. I am not sure if all of those symptoms may be connected. I do have an appointment scheduled with a Rheumatologist in a few days.
Please let me know if my thinking process is correct. I am trying to connect the dots, but the doctors are unconcerned about an autoimmune disorder. It is all very confusing.
Lori, please let me know if you have any suggestions on what I should do or what other doctor I should see; I would be grateful.
Thank you so much for your time and input. Below are some attachments of tests and pictures.

Here are some findings from my 2020 hospital stay and current:
ANA TITER AND PATTERN while hospitalized in 2020

Component Results
Component Your Value Standard Range
ANA Titer 1:80 titer
titer
A low level ANA titer may be present in pre-clinical
autoimmune diseases and normal individuals.

ANA SCREEN/REFLEX TITER/PATTERN while hospitalized in 2020

Study Result
Narrative
Performing Organization Information:
Site ID: EZ
Name: Quest Diagnostics/Nichols SJC-San Juan Capistrano,
Address: 33608 Ortega Hwy San Juan Capistrano, CA 92675-2042
Director: Irina Maramica MD,PhD,MBA
Component Results
Component Your Value Standard Range
ANA Screen, IFA POSITIVE
NEGATIVE
ANA IFA is a first line screen for detecting the presence of
up to approximately 150 autoantibodies in various autoimmune
diseases. A positive ANA IFA result is suggestive of
autoimmune disease and reflexes to titer and pattern.
Further laboratory testing may be considered if clinically
indicated.Reference Ranges for Anti-Nuclear Ab Titer:

1:80 Elevated Antibody Level
ANA Pattern CYTOPLASMIC, RETICULAR/AMA
Coarse granular filamentous staining extending throughout
the cytoplasm (e.g., anti-mitochondrial antibodies). Pattern
is common in primary biliary cholangitis (PBC), systemic
sclerosis, and rare in other systemic autoimmune rheumatic
diseases (SARD).

AC-21: Reticular/AMA
International Consensus on ANA Patterns

BILIRUBIN DIRECT while hospitalized in 2020
Component Results
Component Your Value Standard Range
Direct Bilirubin 5.2 mg/dL
(Based on documented legal sex)

PROCEDURE: US ABDOMEN RUQ LIVER GALLBLADDER PANCREAS while hospitalized in 2020

INDICATIONS: Right upper quadrant pain x12 days with jaundice x3 days

TECHNIQUE: Ultrasound examination of the right upper quadrant of the abdomen was performed.

FINDINGS:
LIVER: No focal liver lesion. The liver measures 16.4 cm in length. The liver is normal in echogenicity. Normal hepatopetal flow is seen in the portal vein.
BILIARY: No intrahepatic biliary duct dilation. The common bile duct measures 4 mm in diameter. No evidence of cholelithiasis but there is a 5 mm and a 6 mm echo without shadowing in the gallbladder neck compatible with polyps. There is gallbladder wall thickening up to 8 mm with trace wall edema suspected but without obvious pericholecystic fluid. Positive sonographic Murphy?s sign.
PANCREAS: No pancreatic duct dilation or focal lesion is seen in the partially imaged pancreas.
RIGHT KIDNEY: No hydronephrosis or suspicious renal mass.
OTHER: Negative.

CONCLUSION:
1. No evidence of cholelithiasis but there is gallbladder wall thickening up to 8 mm with trace wall edema suspected and there is a positive sonographic Murphy sign. These findings suggest acute cholecystitis. Correlation with clinical signs/symptoms and laboratory evaluation is recommended.
2. There is a 5 mm and a 6 mm gallbladder polyp. For a gallbladder polyp in the 6 to 9 mm range.

ANTI SMOOTH MUSCLE, IgG while hospitalized in 2020
Component Results
Component Your Value Standard Range
Actin (Smooth Muscle) Ab IgG

CT ABDOMEN PELVIS W CONTRAST while hospitalized in 2020
Study Result
Narrative
PROCEDURE: CT ABDOMEN PELVIS W CONTRAST

COMPARISON: None.

INDICATIONS: Right upper quadrant and epigastric abdominal pain for 12 days, jaundice.

TECHNIQUE: After obtaining the patients consent, CT images were created with intravenous iodinated contrast.

FINDINGS:
LIVER: No suspicious liver lesion is seen. The portal and hepatic veins are patent. There is minimal periportal edema centrally.
BILIARY: The gallbladder does not appear significantly distended. There is diffuse gallbladder wall thickening measuring up to 8-9 mm in diameter, corresponding to findings on the concomitant ultrasound. No significant pericystic inflammatory changes are detected. Common bile duct measures up to approximately 5 mm in diameter, within normal limits for age.
PANCREAS: No focal pancreatic lesion. No pancreatic duct dilation.
SPLEEN: No suspicious splenic lesion is seen. The spleen is normal in size.
KIDNEYS: No suspicious renal lesion is seen. No hydronephrosis.
ADRENALS: No adrenal gland nodule or thickening.
AORTA/VASCULAR: No aneurysm.
RETROPERITONEUM: No lymphadenopathy.
BOWEL/MESENTERY: No bowel wall thickening or bowel dilation. Visualized portions of the appendix are nondilated and without surrounding inflammatory change.
ABDOMINAL WALL: Tiny fat-containing umbilical hernia.
URINARY BLADDER: No focal wall thickening or calculus.
PELVIC NODES: No lymphadenopathy.
PELVIC ORGANS: Simple appearing cyst/follicle in the right ovary measuring up to 1.8 cm. Mildly lobular uterine fundus, suggestive of uterine fibroids.
BONES: No acute fracture or suspicious osseous lesion.
LUNG BASES: No pleural effusion or consolidation.
OTHER: No intraperitoneal free air, portal venous gas, or pneumatosis detected.

CONCLUSION:
1. Diffuse gallbladder wall thickening, also seen on the concomitant ultrasound, which is nonspecific and can be seen in the setting of acute and chronic cholecystitis as well as low protein states and liver disease. Given the presence of a positive sonographic Murphy's sign on the ultrasound, cholecystitis is suspected. If there is clinical uncertainty, correlation with a HIDA scan (preferably with ejection fraction) could be performed.
2. No dilated bowel loops to suggest bowel obstruction.

MRI MRCP ABDOMEN WO CONTRAST while hospitalized in 2020
Narrative
PROCEDURE: MRI MRCP ABDOMEN WO CONTRAST

COMPARISON: None.

INDICATIONS: abnormal LFTs and RUQ abd pain

TECHNIQUE: Multiplanar and multiparametric images of the abdomen were obtained without intravenous gadolinium contrast. Magnetic resonance cholangiopancreatography was also performed.

FINDINGS:
LIVER: No focal liver lesion is seen. The liver is normal in size and signal.
BILIARY: As documented on previous CT there is evidence of cholelithiasis with gallbladder wall edema as well as edema extending into the hepatic hilum and portal triads. No dilatation of the intra or extrahepatic biliary ducts is seen in the common bile duct measures approximate 5 mm the pancreatic head. No filling defects are seen in the biliary tree area
PANCREAS: No cystic or solid pancreatic lesion. No pancreatic duct dilation.
SPLEEN: No focal splenic lesion is seen. The spleen is normal in size.
KIDNEYS: No suspicious renal lesion is seen. No hydronephrosis.
ADRENALS: No adrenal gland nodule or thickening.
AORTA/VASCULAR: No aneurysm or dissection.
RETROPERITONEUM: No lymphadenopathy.
BOWEL/MESENTERY: No bowel wall thickening or bowel dilation in the partially imaged bowel.
ABDOMINAL WALL: No hernia.
BONES: No suspicious osseous lesion.
LUNG BASES: No pleural effusion or consolidation.
OTHER: Negative.

CONCLUSION:
1. No evidence for biliary duct dilatation. Common bile duct is 5 mm with no filling defects.
2. Consistent with previous CT findings is contracted gallbladder with cholelithiasis and gallbladder wall edema as well as edema in the hepatic hilum and portal triads. This is suspicious for primary gallbladder inflammation and should be correlated clinically.
3. No evidence for pancreatic duct dilatation.
4. No other significant incidental findings.

COMPREHENSIVE METABOLIC PANEL February 2023
Component Results
Component Your Value Standard Range
Sodium 138 mmol/L
133 - 146 mmol/L
Potassium 4.8 mmol/L
3.5 - 5.1 mmol/L
Chloride 105 mmol/L
98 - 107 mmol/L
Carbon Dioxide 25 mmol/L
21 - 31 mmol/L
Anion Gap 8 mmol/L
4 - 13 mmol/L
Blood Urea Nitrogen 18 mg/dL
7 - 25 mg/dL
Creatinine 0.79 mg/dL
0.60 - 1.30 mg/dL
eGFRcr (CKD-EPI 2021) >90 mL/min/1.73 m²
>=60 mL/min/1.73 m²
Calcium 9.6 mg/dL
8.3 - 10.5 mg/dL
Glucose 84 mg/dL
70 - 100 mg/dL
Protein, Total 7.1 g/dL
6.4 - 8.3 g/dL
Albumin 4.4 g/dL
3.5 - 5.0 g/dL
ALT 597 units/L
9 - 43 units/L
Alkaline Phosphatase 118 units/L
34 - 104 units/L
AST 354 units/L
13 - 39 units/L
Bilirubin, Total 0.6 mg/dL
0.2 - 1.2 mg/dL

RECENT TESTING

SMOOTH MUSCLE AB SCREEN February 2023
Component Results
Component Your Value Standard Range
Smooth Muscle Antibody Positive
Negative
Smooth Muscle Ab Titer 1:40
(none)
Positive for Smooth Muscle antibodies. Low titers may be seen in viral infections, malignancies, and in normal patients.

ANA SCREEN/REFLEX TITER/PATTERN February 2023
Component Results
Component Your Value Standard Range
Anti-Nuclear Antibody Negative
Negative
ANA titers and patterns are performed using an immunofluorescence assay technology. Follow up testing for positive specimens, if required, is performed using multiplex bead technology.