British Liver Trust

ALT AST Fluctuate

Hello All,

I have a done a regular check up last year (in November 2016) and the GP noticed that my liver enzymes were slightly elevated ALT = 56 and AST = 42

GP asked me to repeat the blood test in two months and have a Liver ultrasound, which I did. ALT and AST went back to normal range, Hep. A, B and C results were negative and ultrasound results show completely healthy liver.. I was so happy at that time; however my GP advised to repeat the test in six months so in September my ALT = 116 and AST = 56

Ultrasound and X-Ray was done in September 2017 and everything seems normal, no gallbladder or fatty liver found.

Because I was panicking, I have asked to repeat the Tests in Early November, enzymes elevated to ALT = 295 and AST = 119 !!!

I have no idea why does ALT and AST fluctuate that much.

I don't drink/smoke and I don't take any kind of medications, not even Vitamins or any kind of pain killers.

Recently, I was put on Metformin course -to help in getting pregnant! and retested my enzymes in December 2017, ALT came down to 59 !!

Now that I read that Metformin may reduce the liver enzymes, I'm thinking that it could be the reason that brought my enzymes lower.

However I'm very concerned and stressed as I have no idea what's happening in my body.

I'm a Female 29 years old weighs ~110lbm

Would you please know what could be the reason?

I have an appointment with a liver specialist but it's next year and I'm so stressed about it!!

13 Replies
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I forgot to mention that

Sodium,

Potassium , Creatinine ,

Glomerular Filtration Rate (eGFR),

Urate ,

Albumin,

Bilirubin ,

Alkaline Phosphatase all are in the normal range

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I'm in the same boat after suffering drug induced liver injury last year for spinal tumor medication. Mine are in range, out of range, it's frustrating. Scans all good to include MRI, CT, Ultrasound, fibroscan. You Just have to do what you can do, and that's eat healthy, get some exercise, a few walks a week and stay hydrated. Maybe, a fibroscan would be good. I got one, and plan on getting another in March, it will be a year. To see if I'm staying the same, getting better or catching a possible problem.

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Thank you for your reply and sharing your experience. I believe so too; a healthy lifestyle may get things better and if not it doesn’t hurt.

i hope you find yours is getting better in your next check!

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I know sometimes its difficult but try not to worry. There are many many causes of elevated LFTs, not all are likely to have any long term issues. I understand its one of the more common findings when GPs do blood tests. The actual reason why yours seem to fluctuate so much would be difficult for any of us here to comment on. Really only your GP or specialist will be able to do that as only they will have the full picture.

The link below should take you to the BLT page on LFTs:

britishlivertrust.org.uk/li...

Ok, the upping and downing of your LFTs is interesting. However, given that all your other tests have come back normal should be seen as a good sign, so hopefully that should give you some comfort at least.

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Thank you for your reply, you are right I shouldn’t worry much but unfortunately I can’t help it specially when I dig into details and others experience

It’s just so confusing because when I checked my previous reports from 2015 i didn’t have any issues with LFTs

Will keep you posted in the future

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get testedf for Alpha 1 Antitrypsin Deficiency

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Thanks for your reply, would you know if there are other indications for it? Such as symptoms or elevation in other enzymes?

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Did you get tested for Anti-mitochondrial antibodies? (AMA)

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Thanks for your reply

Not as of I know, would you know if there are other indications for it? Such as symptoms or elevation in other enzymes?

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A fibroscan will be of no use. The score can only be interpreted if they know the actual cause of the liver issue. The reason for this is that one score may indicate cirrhosis if you were suffering from alcoholic hepatitis and this same score could indicate fibrosis if you were suffering from Hep C. These are examples and not necessarily the exact interpretation of the scale. I am merely trying to demonstrate that unless they were to know the cause of the possible liver damage, then the number they would get is simply that, just a number.

One possibility is AIH (auto-immune hepatitis), which you cannot catch, but is thought to be possibly caused by some medications among other things. I am not suggesting you have it from the data that you have shared, but it is something to ask about as a possibility. It is caused by your own immune system and can be treated with medication. The earlier it is caught the better. Good luck with the investigations and hopefully it is just fluctuating levels and nothing to worry about :)

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Thanks for your reply, One of the reports show that I’m not immune for Hep B

Hep. B immunity <^2

Not sure if this is actually related to what you are mentioning here

I will ask my GP about it

Thank you so much for your input

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Sorry I haven't explained myself fully enough. Hep A through to Hep H are all viral. I'm afraid, not being familiar with them all, I don't know how each one is contracted, but when they say you don't have immunity to Hep B, it means that if you came into contact with anyone carrying Hep B, you could contract it. You can have a jab for Hep B and acquire immunity this way. (You know the same as a measles jab)

AIH is a totally different kettle of fish. Your own immune system attacks your liver. It cannot tell that the tissue is healthy. There are many types of auto-immune diseases, MS (multiple sclerosis) , lupus and rheumatoid arthritis are all types of auto-immune disease. In each of these cases your own immune system attacks a healthy part of the body. As yet the reason for each of these occurring is unknown.

I hope this clarifies things for you. Please ask if you need further clarification. With regard to the fibroscan being over a certain number, I would regard this information with caution as normal everyday infections can give rise to higher fibroscan readings (as I understand it and still you & the doctor know nothing). As a rule of thumb, most people have a fibroscan after all the other diagnostic tests have been done. In 10 years of being treated for AIH, I have had 2 fibroscans and the first one was done years after initial diagnosis, hence my advice.

As for a biopsy, again this will only be carried out for confirmation purposes if they feel it is necessary. They will need to have ruled out other causes and conditions before taking this step as it does carry an element of risk.

I wish you all the very best. At the moment, they will be working their way through possible causes and ruling things out. It may seem to be taking a while, but while your ALT levels seem high to you, they are not as bad as you fear, especially now they have come back down, hence the doctors taking their time to carefully consider what could be wrong.

Let's hope they find the cause soon and put your mind at rest. Good luck :)

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MSSD have you seen a hepatologist or GI doctor? Normally, one of the first things they run is blood panels for AMA and Macroglobulins. The fibroscan won't give a diagnosis, but at least will show if the liver has been sustaining damage that's susceptible to turning into fibrosis. Yes, it won't give the cause. If it comes back 7KPA or higher, normally a biopsy will be used for investigation.

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