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Elevated AST and ALT
by wynblyn, Oct 27, 2009 04:29PM
I'm a 42 year old woman and I've been feeling absolutely crummy for the past three weeks. Been nauseaus after I eat with stomach cramps and general discomfort, loss of appetite, and weight loss. I finally went to my doctor last week to say this was too much and asked for a full blood workup, The results were shocking - low potassium (3.1), TSH is off (.033) and AST is high (132) so is ALT (320). Last time we checked in January, AST was 23 and ALT was 37, potassium was FINE and so was TSH. Went to my neurologist today, and he believes the Topamax may pushed up the AST and ALT (150mg daily) so we're suspending it. I've been taking Topamax for years as migraine prophalaxis, I'm not epileptic. I also take HCTZ for my blood pressure and there are known issues with Topamax and HCTZ causing serum potassium depletion when combined, so this may address the hypokalemia issue as well. I'm off to the endocrinologist tomorrow to address the TSH issue, since I've been on 100 mcg of Synthroid and that was just fine ten months ago, but doesn't seem to be now (I'm hypothyroid). My GP will be doing bloodwork again in three weeks, but I wonder how long it will be before I stop feeling so nauseaus and crampy and if this is even related to the liver enzyme levels at all. I'm still very worried about these AST/ALT numbers - it's all I can think about, frankly. Should I just go to my gastro or wait until the next round of blood results to see if things improve?
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Many a times AST and ALT (both are collectively called transaminases) rise without any cause. Because AST is found in many other organs besides the liver, including the kidneys, the muscles, and the heart, having a high level of AST does not always (but often does) indicate that there is a liver problem. For example, even vigorous exercise may elevate AST levels in the body. However to reach at that conclusion the medical causes of these raised transaminases have to be ruled out. Causes of liver transaminase elevations include viral hepatitis, alcohol use, medication use, steatosis or steatohepatitis, and cirrhosis. Steatosis and cirrhosis are ruled out by the ultrasound. Other common health conditions, such as diabetes, heart disease, pancreatitis, hemolytic anemia and thyroid disease, can also cause liver transaminase elevations. Most liver diseases are characterized by greater ALT elevations than AST elevations except cirrohsis and alcohol abuse.
In your case the raised enzymes are due to both Topamax and hypothyroidism. With raised enzyme levels and a persistent nausea a stool test and an abdominal ultrasound should be done to rule out the other causes.
Restrict the intake of fat and oils and take an antacid. Take frequent small meals. This may help you. Please let me know if there is any thing else and do keep me posted. Take care!