elevated GGTP, AST, ALT and Alkaline Phosphatase

[Laurie_ski]

Hi,
I have no symptoms (feel fine), but two recent bloodtests have revealed elevated GGTP, AST, ALT and Alkaline Phosphatase.  I'm a 35 year old female.  Excellent personal and family health history. 5 foot 7...141 pounds. Light to moderate drinker (one beer a day).  Just had a baby a few months ago.  Lifetime history of low blood pressure, but had quite high blood pressure on the day I delivered my son and a few weeks afterwards.  Kidney stones in Nov of last year.
Medications currently taking daily: 5 Micrograms Synthroid and a prenatal multivitamin.  Recently tested negative for Hep B and Hep C.

April 18th bloodwork: GGTP: 111, AST: 63,  ALT: 82   AP: 151
June 19th bloodwork:  GGTP: 120, AST: 82,  ALT: 188, AP: 169
June 26th bloodwork: Iron, coagulation and anti-mitochondrial are all fine.  Anti Nuclear Antibody: 1/320

I'm scheduled for an abdominal ultrasound next week.  Doc says he needs more info but thinks it might be cholestasis.
My question:  I have read a LOT in these forums so I know the many diseases that elevated liver enzymes can indicate.  Please don't list all of them for me! :)  I'm looking for a subset of that list.....a list of things that it could be, BASED ON MY PERSONAL BLOODWORK, not on just a generic "elevated enzymes" list of possibilities.   And/or it would be very helpful to tell me what "high liver enzyme diseases" that I can rule out at this point.  For instance, doc said that I don't have hemochromatosis since my iron looked fine.  He was only willing to chat with me on the phone for a couple of minutes, though, which is why I'm seeking your expertise.  Thank you very much!

[Kevin Pho, MD]

Hello - thanks for asking your question.

Erin has nicely summarized the causes below and I agree with her assessment.  One comment about the ultrasound.  With the history of alcohol, fatty liver should also be considered.  This can be seen on an ultrasound and could be a possibility why your enzymes are elevated.

Hyper or hypo thyroidism can elevate liver enzymes, so make sure that your synthroid dose is appropriately controlling your TSH.

A rare cause would be Wilson's disease and can be checked with a ceruloplasmin level.  This is unlikely, but is a treatable liver disease.

If all the tests are not-revealing, I would repeat the tests off alcohol, and consider a liver biopsy if the enzymes remain greater than two-fold elevated (i.e. greater than 80).

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.

Thanks,
Kevin, M.D.

[GI.PA]

Ok...I'll take a shot at this, being a very common referal to our neck of the woods.

First your transaminases are mildly elevated suggesting a low grade inflammation of the liver.  This would argue against an acute liver disease (such as drug induced hepatitis or Hep A).  Viral studies for Hep B and C were negative, scratch them off the list.  Your normal coagulation studies suggest normal liver functioning making severe liver dysfunction unlikley.

A sonogram is a good way to image the liver but will mostly likely show a normal liver with normal echotexture, but can help rule out the scary stuff (liver cancer).

Things that pop out.  You have a moderate elevated ANA making me suspicious for autoimmune hepatitis.  I would approach this with more lab work (anit-smooth muscle antibody, anti-LKM, immunogloblulins) and a liver biopsy (gold standard for diagnosis.  Your demographics (woman, 30-40's) fits for this disease.  Other possibilities:  Celiac sprue ( a strange, and sometimes asymptomatic gluten allergy) can be test for by endomysial antibody) and your known thyroid disease being a little out of wack (a simple thyroid panel would suffice).

Hope this helps..!

Erin
Gastro-Physician Assistant (GI.PA)

This answer is no substitue for real medical advice.  Personal follow-up with your physician is essestial for adequate diagnosis and treatment reconmendations.

[Laurie_ski]

Thanks, Erin, that was very helpful!

[Laurie_ski]

Thanks, Kevin MD...very helpful!

[tealeaves]

I have a similar situation.  I am 29 years old, do not drink alcohol, had a baby three months ago.  I had high blood pressure on the day of delivery.  I had severe itching with no rash for two weeks preceding delivery.  I now have no symptoms, but have had increased liver enzymes since delivery.  I am also on Synthroid, (have been for 5 years).  I get an abd ultrasound tomorrow.  

I wonder if being on Synthroid contributes to liver problems during pregnancy??

[sandy957]

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[brealbtrue]

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