Abnormal Liver Enzymes: Causes and Concerns - Gastroenterology and Hepatology

Abnormal liver function tests?

In July, blood tests revealed abnormalities in blood sugar, liver enzymes, and cholesterol.
The cholesterol issue had been noted since high school health checks, and the physician later believed it to be hereditary (as my mother also has this issue).
I have been taking 10 mg of atorvastatin (Lipitor) for about three months, resulting in a decrease in cholesterol from 333 to 246 and triglycerides from 193 to 118.
However, blood sugar levels increased from 104 to 109 (previously consistently around 100).
Later, at another clinic, the physician suggested switching the medication to another atorvastatin brand.
During the period of taking cholesterol medication (in June), I had chickenpox and took medication for about two weeks (cough suppressants, analgesics, antipyretics, antihistamines, and expectorants).
Additionally, I have a history of migraines and typically take Japanese EVE pain relievers (which I have used since I was 20).
During the period in June when I was taking EVE, I also consumed alcohol (about 1-2 glasses of red wine or plum wine).

I have a few questions for the physician:
1.
Given my current liver enzyme levels of AST 69, ALT 147, and GGT 155, is it possible that this inflammation is drug-induced? Is it acceptable for the clinic physician to suggest monitoring the situation for a while before retesting?
2.
I received the hepatitis B vaccine, and in October 2018, my antibody levels were still present.
After discovering in March 2019 that my partner is a hepatitis B carrier, I was concerned that the vaccine's effectiveness might diminish after 10-15 years, so I received a booster dose.
Could this action have any adverse effects on my body?
3.
Additionally, in early 2020, my thyroid blood test showed a slightly low FSH level of 0.389 (normal range 0.55-4.78), while T4 was normal at 8.7.
Could this condition have any related effects?

T, 20~29 year old female. Ask Date: 2021/08/13

Dr. Chen Shidian reply Gastroenterology and Hepatology

1.
If other causes are excluded, be cautious of the side effects of lipid-lowering medications.

2.
No, it won't.

3.
It shouldn't either.

Reply Date: 2021/08/13

More Info

Understanding abnormal liver enzymes is crucial for diagnosing and managing liver health. In your case, the elevated liver enzymes—AST (69), ALT (147), and GGT (155)—indicate liver inflammation or damage. There are several potential causes for these abnormalities, including medication effects, viral hepatitis, alcohol consumption, and metabolic conditions.

1. Medication-Induced Liver Injury: Given your history of taking atorvastatin (妥寧) and other medications, it is possible that these could contribute to your elevated liver enzymes. Statins, while generally safe, can occasionally cause liver enzyme elevations. The combination of medications you mentioned, including cough suppressants and antihistamines, along with alcohol consumption, could also exacerbate liver stress. It is advisable to monitor your liver function closely, especially after any changes in medication or health status. Your doctor’s recommendation to observe and retest in a few weeks is reasonable, as liver enzyme levels can fluctuate and may return to normal once the offending agent is removed or the body recovers.

2. Hepatitis B Vaccination: You mentioned receiving the hepatitis B vaccine and subsequently getting a booster. This is generally safe and can help maintain immunity, especially since your partner is a carrier of the virus. The vaccine is effective for many years, but immunity can wane over time. Boosting your immunity with an additional dose is a common practice and should not negatively impact your health. It’s important to ensure that you are protected, especially in the context of potential exposure to hepatitis B.

3. Thyroid Function: Your thyroid function tests indicate a slightly low FSH (0.389) but normal T4 levels. While thyroid function can influence metabolism and overall health, a low FSH level is more indicative of pituitary function rather than directly affecting liver enzymes. However, thyroid disorders can sometimes coexist with liver issues, particularly in autoimmune conditions. It would be prudent to discuss these results with your healthcare provider to determine if further evaluation or monitoring is necessary.

In summary, your elevated liver enzymes could be attributed to a combination of factors, including medication effects, lifestyle choices (like alcohol consumption), and possibly underlying metabolic conditions. It is essential to maintain regular follow-ups with your healthcare provider, who may recommend lifestyle modifications, further testing, or adjustments to your medication regimen based on your liver function and overall health status.
In addition to monitoring liver enzymes, consider lifestyle changes such as adopting a balanced diet, engaging in regular physical activity, and avoiding alcohol to support liver health. If your liver enzymes remain elevated or worsen, further investigation may be warranted to rule out other causes, including viral hepatitis or autoimmune liver disease. Always communicate openly with your healthcare provider about any concerns or symptoms you may experience, as early intervention can significantly improve outcomes in liver health.

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