Hello I have elevated liver enzymes Ast and alt mid forty

Patient

Q: Hello
I have elevated liver enzymes. Ast and alt mid forty range. Igg at 29. Fibroscan and ct and ultrasound all good. My hepatologist thought because of my igg i should be tested for autoimmune hep. All tests were negative. Also tested for hep a b c. I used to drink about 10 drinks per week but have stopped for the last 2 months. Still not a change in enzymes. Any ideas what this could be? I do take synthroid because of hashimotos.

Doctor

A:   Hello,
Thank you for your query at AskTheDoctor.com
I understand your concern.

Your liver enzymes are only mildly elevated and that can be present even among normal people who will be completely asymptomatic. It could indicate a more fatty diet or people with slightly higher BMI can also have slightly deranged liver enzymes.

As of now, there is no need to do further investigations or other intervention. I will advise you to avoid drinking as well as avoid intake of very fatty or spicy food. Have more of green leafy vegetables and fruits. Try to exercise daily for 30-45 minutes and repeat the values after 3 months. If you want prophylactically you can take silymarin syrup two teaspoons twice daily for 1 month. This will also enhance faster recovery.

Hope this was helpful,
Feel free to discuss further,
Regards.

Comments / Follow Ups

Patient: Thank you. The Dr thinks I should have a Biopsy next month but I think I will postpone for a bit. I am canadian and I went to the U.S. to see the hepatologist. He would like me to have the biopsy which would cost thousands of dollars out of pocket and I'm not convinced it's necessary.
Doctor: Hello,
I am not sure why he wants the biopsy.
This kind of elevation is present even in normal asymptomatic population.

I will advise you to follow a good diet, exercise, avoid drinks and repeat the values after 3 months. If its elevated then you can go ahead with further investigations.


Regards.
Patient: I do have one more question. In the beginning I cut way back on alcohol with no results. When I finally stopped cold turkey my enzymes were almost normal. Then I went out and had only 1 small glass of wine. A week later they were back up again. Could such a small amount of alcohol affect my liver while it is healing?
Doctor: It should not, however alcohol is not the only thing that affects liver. Even diet or lack of exercise can have similar effects. Please do not worry.


Regards.
Patient: Also I do have raised immunoglobulin g levels which I realize is present in autoimmune hep but ive read it can also be elevated in hypothyroid which I have. Is this correct? I assume it's a good sign all my autoimmune hep tests were negative?
Doctor: Yes, it's definitely a good sign that all the autoimmune parameters are negative.
I have to see the igg report to be able to comment on that.

Regards.
Patient: What info could I give you on the report? I've been really worried about this. The normal high is 18 and mine is 29 but I have read hashimotos disease can also have elevated igg. Have you ever heard this? Thanks so much for your time. My Dr really doesn't tell me much.
Doctor: See IGG is an antibody which is indicative of a chronic infection.
You need to tell me what IGG test you got done.

Regards.

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