Should blood test come back normal if you have been told you have extreme fatty liver?

They can: Fatty liver (steatohepatitis, and non-alcoholic steatohepatitis (nash))once was thought to be "not that bad" but we now recognize it as a serious liver problem. Common in folks with diabetes/cholesterol problems. It is common to pick it up because of abnormal liver enzymes on bloodwork; however those labs can be normal, too. Worst case is normal labs because the liver is badly damaged/cirrhosis.

Liver test: Fatty change can happen in the liver from a varity of diverse causes and most liver function tests may remain normal or mildly elevated if there is no associated inflammation or fibrosis.

Can: If the liver isn't actually inflamed, the liver enzymes (which indicate acute liver injury, not "function") will be normal. Trust your radiologist to diagnose marked fatty liver accurately, and seek an underlying cause (smoldering hepatitis c and the metabolic syndrome are both life-threateners.).