Is an enlarged liver 'par for the course' with NAFLD?

[Ladyofthelake50]

Hi everyone.

I'm new to this disease and trying to get a better understanding. I'm guessing my liver has been fatty for some years already, but my liver enzymes in March 2019 were normal. Then I started taking Tamoxifen for breast cancer tx. The next few blood tests showed my ALT at around 60. I coincidentally had a CT scan around this time which showed steatosis. My oncologist wasn't concerned until my ALT went up to 85 recently, and told me to see my PCP, who ordered an ultrasound. It says I have hepatomegaly, measuring 19.6cm. Is this a finding that normally occurs with a fatty liver? I have a feeling the Tamoxifen has negatively affected my liver. I have an appointment with a gastroenterologist in 2 weeks. Incidentally, I was also just diagnosed with hypothyroidism, which I've read also affects the liver. I've lost 9lbs since starting the thyroid meds 3 weeks ago. My BMI is 25, so I only just make it into the overweight category. Also, what does a normal AST, but above normal ALT mean? Thanks for any input you may have.

[nash2 Partner]

Hi Lady

Tamoxifen can cause liver damage so that needs to be watched closely and a liver that is fatty or in distress is commonly enlarged. Some people are fairly lean but still have fatty livers but it is less common but the combination is a risk factor. Hopefully your gastro doc has a liver sub-specialty. That is important because many gastro folks aren't really well versed in liver management. If you have any question about that you might try to get a hepatologist added to your care team. If your AST/ALT ratio gets over 1 you should definitely seek a hepatology consult as that suggests advancing liver stress. A high ALT means more liver cells than usual are dying but your damage clearing functions may be handling it. It is that balance that you want your docs to be watching. Good luck

Wayne

[Ladyofthelake50 in reply to nash2]

Thank you. I will wait and see what the gastro doc has to say. I may refer myself to a specialist if I’m not confident in him. Every time I mentioned the ALT levels to my oncologist they say it’s not the Tamoxifen, which is frustrating when I see so many studies say it does affect the liver. I looked up my ast/alt ratio and it’s 0.44 because my ast is still in normal range of 34. All other results such as bun, albumin etc are normal, so I guess that’s a good thing.

[nash2 Partner in reply to Ladyofthelake50]

All of these markers are just guides to probabilities. Having your AST low even with a high ALT would generally be favorable for you. The challenge with any of these powerful drugs like tamoxifen is that there are always people for whom they are harmful and sorting out who has the risk is not easy. The thing about problems like this is the tendency to ignore it until symptoms occur. We don't want you to be afraid of it but being aware is the proper course.

[Ednoral]

Look up side effects of Tamoxifen. It lists them and one of them is signs of liver disease. Maybe the drug company doesn't want the doctors to admit it after all it's all about money with drugs. IMHO.

[Ladyofthelake50 in reply to Ednoral]

Thanks. I am aware it’s on the list of side effects. I think the problem is that physicians will go with the more likely causes first before considering a medication issue that only affects a very small percentage of takers. There are a lot of listed side effects with Tamoxifen, but not taking it is a risky thing too.