A 46-year-old female presented to her general practitioner because of fatigue. In her past medical history the patient has hypothyroidism and is substituted with levothyroxine. The initial workup showed normal TSH levels, no signs of anaemia but elevation of ALP (3 x upper limit of normal), minimal elevation of AST, ALT and GGT (all below 1.5 x upper limit of normal) with normal bilirubin. A control exam 6 months later confirms the ALP elevation as well as slight elevation of AST, ALT and GGT.