What Causes Elevated ALT And TSH Levels?

Posted on Tue, 27 Oct 2015

Question: Good afternoon. I had some bloods taken recently on admission to ER with paroxysmal AF who required cardiocersion after oral pill in the pocket flecainide at home was unsuccessful. All bloods were normal apart from raised ALT and slightly raised TSH. All LFT normal apart from raised ALT OF 74. TSH was elevated at 6.2 with normal T3 and T4. No other medical history apart from paroxysmal AF. I am now on 5mg bisoprolol.. Low alcohol intake and normal cholesterol and glucose. Otherwise well. Iron levels within normal range but at high end of normal. Have had course of hepatitis B immunisations 10 years ago and negative hepatitis c result at work (healthcare worker). Bloods taken again a month or so after admission demonstrated raised ALT at same amount. Concerned about this result. Please advise...

Answered by Dr. Dr. Klerida Shehu (5 hours later)

Brief Answer:
Alcohol,Cocodamol may increas ALT level

Detailed Answer:
Hi and thank you for asking!
I read carefully all your concerns and I can say as follows:

1.You are reporting to have ALT level 74. It is slightly elevated. You are using bisoprolol and co -codamol. I need to know what is your Co-codamol dosage and for how long have you taken it? How much alcohol are you using per week?

The reason of my questions is that both alcohol and co-codamol can increase ALT level.

Another possible cause of your ALT level may be drug interaction between bisoprolol and Co-codamol.

2.With regards to TSH level it is raised and is suggestive for under active thyroid.

Since T3 and T4 are normal you need to do TPO Ab and Tg Ab to rule out /confirm hypothyroidism.

Meantime I suggest to :
- stop alcohol use
- stop co-codamol use
- repeat ALT and AST after 2-4 weeks
- perform abdominal ultrasound to better evaluate liver structure.

Hope it was helpful to you!

Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (9 hours later)

Thanks. Alcohol wise I drink 3 pints of 4% alcohol twice a week on average. Co codamol no more than 60mg codeine and 1g paracetamol per 12 hours.
Busoprolol was started post raised ALT bloods. Could the blood results indicate something sinister such as cancer?

Answered by Dr. Dr. Klerida Shehu (23 hours later)

Brief Answer:
Please

Detailed Answer:
Hi back
Sorry for my late.

Please bare in mind that Alt level is not indicative for cancer.
It is indicative only for liver damage.

You are reporting to have used 2 g paracetamol per day. If you have used it for a long time it can increase ALT level.

To my opinion discuss with your physician to stop co codamol use.

With regards to alcohol use even it is is not a large amount, you should stop it a least 4-6 weeks. Alcohol effect on a damage liver is much more than alcohol effect on a healthy liver.

hope it was helpfull
Dr. Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (29 minutes later)

Thanks. So can I presume if it was something more sinister other enzymes would be elevated apart from ALT Thanks

Answered by Dr. Dr. Klerida Shehu (2 hours later)

Brief Answer:
Please follow

Detailed Answer:
Hi back

If you will have a more serious issue it would be a different clinical symptoms, and blood work findings.

You have only mild elevated ALT level and it is well explained by alcohol and co codamol.

So there is nothing to be worried related cancer issues.

Dr.Klerida

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar