Elevated ALT

I am a 42 year old male, non-smoker, moderate drinker, not overweight with recently diagnosed Hypothyroid(taking.75MM Synthroid) about 10 months ago. I had my gallbladder removed 3 years ago for gallstomes and for the past 20 years, I have had a mildly elevated liver function that always drops somewhat when I do not drink alcohol. My labs as of April 2005 were as follows:
AST-34
ALT-79
Total Billirubin-0.8
Direct Billirubin- 0.15
Alkaline Phosp-116
Total Protein-7.1

I have never had any significant symptoms such as jaundice, bloating , etc. Here are my questions:

1. Are Gallbladder and Liver disease related?
2. Could this be an indication of PBC?
3. How long is reasonable to avoid alchohol to allow the liver to heal and re-test? I have been alchocol free for 2 weeks.
4. Should I try Milkweed Thistle? Does it help?
5. Given the above, what would you suggest?

PS- I have been tested for Hepatitis A, B & C which were all negative.

Thank you!

[Kevin Pho, MD]

To answer your questions:
1) Yes, gallbladder and liver disease can be related.

2) PBC is one of the many reasons that can elevated the liver enzymes.  PBC typically occurs more in females.  Blood tests to suggest this disease would be a markedly elevated alkaline phosphatase level and the presence of antimitochondrial antibodies.

3) It would be reasonable to abstain from alcohol for 1-2 months, then repeat the liver enzymes.

4) There is no data supporting the use of milkweek thistle.

5) I would consider a liver ultrasound to image the liver.  If the enzymes continue to elevate, an MRCP can be considered to evaluate the biliary ducts.  The liver biopsy is the most definitive test.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b