Elevated Liver Enzymes After Four Months
At 27 years old, weighing 180 pounds and taking no medications, I opted to start Semaglutide four months back, prompting a routine lab work session. Initially, my liver enzyme levels were as follows: AST was 27, ALT stood at 20, total Bilirubin was .5, and Alkaline Phosphatase measured 64. Given my family history of diabetes—both my grandparents had it—I consistently keep an eye on my glucose levels. At the time of this testing, my glucose reading was 105, leading me to begin Semaglutide. Recently, my partner and I agreed to consider starting a family, which led me to stop taking Semaglutide a month prior; I had been on it for three months. Additionally, I discontinued birth control about six weeks ago after nearly nine years of continuous usage. Fast forward to this week, I underwent another round of blood tests to assess my glucose levels again. There was a positive change; my glucose is now at 93, and my A1C is 5.0. However, I was alarmed to discover that my liver enzyme levels had risen significantly: AST now reads 44 and ALT has soared to 114. My total Bilirubin is .8, with Alkaline Phosphatase at 62. The clinic has suggested I schedule a follow-up test in about three weeks, but I am genuinely worried and contemplating whether I should seek additional medical attention sooner. I don’t consume alcohol or smoke, and while I am classified as overweight, I engage in mild to moderate exercise at least three times a week. Historically, my AST and ALT levels have never been elevated, making this sudden increase particularly concerning.
Answers (1)
6/19/2025, 5:01:37 PM
OpenHealth AI
It's understandable to feel concerned about your elevated liver enzyme levels, especially since you've noticed such a significant change in a short period of time. Let's break this situation down to ease your worries while focusing on appropriate next steps.
Summary of Your Situation
- Your liver enzymes (AST and ALT) have significantly increased since you started Semaglutide and stopped birth control, while your glucose levels have improved.
- You are at risk for liver issues given your elevated levels, especially since these are new findings for you.
Understanding Elevated Liver Enzymes
Liver enzymes like AST (aspartate aminotransferase) and ALT (alanine aminotransferase) can increase due to several factors, including medications, weight, diet, and changes in body metabolism. Semaglutide is known to potentially affect liver enzymes, although significant liver enzyme elevation is not very common. Additionally, these changes could be influenced by your recent discontinuation of birth control and any other lifestyle factors.
Immediate Next Steps
-
Monitor Symptoms: Keep an eye on how you're feeling. Note any new symptoms such as fatigue, abdominal pain, or jaundice (yellowing of skin or eyes), which could indicate liver distress.
-
Dietary Adjustments:
- Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while minimizing processed foods, sugars, and saturated fats.
- Ensure you stay well-hydrated.
-
Exercise Regularly: Continue with your exercise routine, aiming for at least 150 minutes of moderate aerobic activity each week, which can help maintain a healthy weight and support liver health.
-
Avoid Alcohol and other Toxins: Since you're abstaining from alcohol and smoking, continue to do so as these can exacerbate liver issues.
-
Follow-Up Testing: Attend the follow-up test in around three weeks as suggested. Your healthcare provider can further evaluate trends in liver function and determine appropriate next steps.
When to Seek Immediate Attention
If you experience any of the following symptoms, consider seeking medical advice sooner:
- Severe abdominal pain or swelling
- Persistent nausea or vomiting
- Unexplained weight loss
- Dark urine or pale stools
- Yellowing of your skin or eyes
These indications could point to a more significant liver issue that may require immediate intervention.
Final Thoughts
It's natural to feel anxious about your results, but keeping track of your symptoms and following the outlined steps can help you manage your health effectively. You're taking proactive steps by monitoring your blood work and managing your glucose levels, which is commendable. If your concerns remain or worsen, don’t hesitate to reach out for further evaluation and support.
Related Questions
Seeking Clarity on a Pediatric Surgical Experience
One of my earliest recollections involves surgical gauze wrapped around my genitals and being cautioned to exercise caution regarding my circumcision. This incident dates back to around 1972, when I was roughly three years old. My brother, who was eleven at the time, corroborates this memory and recalls that the bandage remained in place for "a few weeks." His recollection is a bit unclear, but he does remember seeing me running around without pants and with a gauze dressing. He believes the dressing wasn't overly bulky and doesn't recall any stent being used. However, I am aware that his memory may not be completely accurate based on other conversations we've had. He recalls being informed that I underwent surgery for an undescended testicle, yet was never made aware of a circumcision being involved. Later, a physician indirectly confirmed that I had undergone an early orchidopexy. This memory piques my curiosity, particularly since my parents have never brought it up with me. I have knowledge of having glanular/coronal hypospadias, and the details of my situation appear to align with images I’ve encountered depicting partial hypospadias corrections. This leads me to wonder if my circumcision might have actually been related to hypospadias surgery. Unfortunately, any tangible proof of these events was lost when I underwent gender confirmation surgery as a trans woman three decades ago. It's conceivable that the standard circumcision procedure typically performed at birth could have been postponed, given that I was born slightly premature and had significant Rh disease and hypoxia. But could it have been deferred until I reached the age of three? I have made attempts to obtain my medical records, but unfortunately, they have been destroyed over the years. While I understand that definitive answers may be elusive, I would greatly appreciate any insights or thoughts on this matter.
Concerns About Potential Peripheral Artery Disease (PAD)
For the past three to four years, I have been dealing with a persistent numbness in my left foot. Initially, I suspected it might be due to a pinched nerve or perhaps something similar, but the sensation has never completely returned. As time has gone by, I've encountered additional worrying symptoms: - My feet have started to develop a purple hue, particularly evident when I sit in positions that put pressure on my legs or when I take a shower. This discoloration has become one of the most alarming signs of my condition. - The growth of my toenails has slowed considerably, and they now appear uneven and ridged. - Additionally, my feet have a temperature that feels significantly colder than the rest of my body, and they no longer grow hair as they once did. I do not smoke and I’m not diabetic; however, I have high cholesterol and received an elevated result on a lipoprotein test. The prospect of PAD is frightening to me, as it seems synonymous with a grim future. I have been referred to a cardiologist, but they are reluctant to conduct an Ankle-Brachial Index (ABI) test since I am under 35. I want to remain hopeful and believe I don't have PAD, yet I struggle to identify any other plausible explanations for these symptoms. What could be potential alternatives to consider, if any exist?
Expectorated Large Tissue with Blood
At 28 years old, I experienced a fever the previous night, after which I had no other cold symptoms. To my surprise, today I coughed just once and expelled a significant piece of tissue mixed with blood. Following this alarming incident, I sought medical attention at an urgent care facility because I developed a headache immediately afterward and felt a peculiar "butterfly" sensation in my chest. The healthcare professionals did not conduct any laboratory tests or imaging studies, instead opting to prescribe antibiotics for what they suspected might be an infection. Is this an appropriate response to my situation? This is quite concerning.
Experiencing Uncertainty: Possible Ischemic Attack?
Greetings, everyone, including healthcare professionals. For the past year, I've been managing high blood pressure, and I'm currently prescribed a regimen that includes Amlodipine at 10 mg and Bisoprolol at 5 mg. At 44 years old, I’m a woman who is classified as overweight and also deals with hypothyroidism, low ferritin levels, liver issues, and slightly elevated cholesterol levels. Typically, my medications maintain my blood pressure within a range of 110/70 to 140/80. However, two days ago, I experienced a stressful episode, causing my systolic pressure to spike to 155/95. Upon standing, I sensed weakness in my left arm, which felt as if it were slightly twisting. A wave of panic hit me, and I feared I might be incapacitated or having a stroke. Despite my anxiety, I was still able to grasp a glass and tightly close my fist. Briefly, my right arm felt a mild sensation that lasted only a second. This peculiar feeling persisted for roughly a minute. I then consumed some mint tincture mixed with alcohol and engaged in deep breathing exercises, which remarkably alleviated my symptoms and brought my blood pressure back to a stable level. I contacted my physician, who inquired about my symptoms and their duration. Aside from the discomfort in my arm, I wasn't experiencing any additional issues. A second doctor relieved me of any immediate concerns regarding the necessity for an MRI, and since I underwent one a month prior that showed no abnormalities in my cranial blood vessels, I felt some reassurance. Now, back home and with lingering fears of having experienced an ischemic attack, I wonder if an ultrasound of the neck arteries is warranted. Do my symptoms indicate a potential attack? What steps should I take next? Has anyone faced a similar situation? Thank you all for your insights.
Concerns About Potential Misdiagnosis
Hello everyone, I recently stumbled upon this subreddit and felt it would be the ideal platform to share my experience. I initially posted something similar under r/Asthma but soon realized that this community might be more appropriate for my concerns. To provide some context, I’m a 25-year-old woman with no personal history of smoking, although I have been heavily exposed to secondhand smoke throughout my life. There is a family history of asthma and COPD on my side. I was diagnosed with asthma during childhood but seemed to outgrow it as I got older. Throughout my younger years, I frequently battled respiratory and sinus infections, and in my teenage years, I suffered a severe case of walking pneumonia. Following that episode, my breathing worsened significantly, prompting my doctor to reinstate the asthma diagnosis and prescribe albuterol inhalers without performing any additional tests except for an X-ray to confirm the pneumonia had resolved. Over the years, I’ve noticed a gradual worsening of my symptoms. Each primary care physician I've consulted has prescribed various inhalers and medications, but the relief they provide has been minimal. For years, I have dealt with a persistent dry cough described as that of a seasoned smoker, yet my doctors continuously assured me it was merely asthma, claiming that my inhalers would alleviate it. When a coughing fit does occur, it can be so intense that I end up gagging, losing control of my bladder, and feeling dizzy. Fast forward to two weeks ago: my cough intensifies with physical activity, and I have a physically demanding job. Typically, my inhaler assists me with breathing, but in this instance, it was ineffective, and emergency services were called to administer oxygen. My oxygen saturation dropped to 93% until the oxygen and my rescue inhaler were applied. I declined hospitalization after feeling better with the oxygen. I took a day off work to recuperate. I managed to see my primary care doctor afterward. Having been on Advair and albuterol for years, I was also prescribed Singulair last year due to flare-ups. In my recent visit, my doctor substituted my Ventolin (albuterol) with Airsupra and introduced Spiriva, along with short courses of Mucinex and Prednisone. At the appointment, my lungs sounded clear, and my oxygen levels were between 99-100%. There was no wheezing, just persistent coughing. Returning to work the following Thursday proved challenging; within three hours, I experienced another severe coughing episode that felt as if my throat might rupture. I was gagging, tearing up, and struggling to remain upright, feeling dizzy and breathless. Several doses of my rescue inhaler provided little relief, and emergency services were contacted again; I was subsequently transported to the emergency room. My oxygen saturation was stable at 97-100%, yet I continued to feel breathless and my painful coughing persisted. Respiratory treatments seemed to exacerbate the coughing, and magnesium failed to provide relief. Both the paramedics and ER staff expressed concern when I mentioned my chronic cough that had persisted for years without improvement. Initially, emergency responders detected only a faint wheeze and diminished lung sounds on one side, although they later reported normal findings. No fluid or wheezing was noted, just continued coughing. CT scans and X-rays of my throat and chest returned normal results. After three days in the hospital, my lactic acid and CO2 levels returned to normal. Despite being treated with steroids and cough suppressants, I found no alleviation of my symptoms. I have now received urgent referrals to a pulmonologist, an ENT specialist, and an allergist, and I recently followed up with my primary care physician. Her only recommendation was cough drops and to wait for my upcoming Pulmonary Function Test (PFT). Additionally, the hospital prescribed Pantoprazole for potential GERD, which hasn't significantly helped. My follow-up blood tests revealed that while my CO2 levels improved, they still remain low, and there are no current indications of an autoimmune disorder, though I am awaiting several results. After undergoing the Pulmonary Function Test, the findings were unusual. Though I await an appointment with the pulmonologist, I reviewed the notes from my test. They indicated, "Spirometry is normal. Lung volumes demonstrate hyperinflation and air trapping. Diffusing capacity is normal. No substantial bronchodilator response observed." When I inquired with the technician who administered the test, she mentioned two possibilities: either my lungs weren't inflamed enough to demonstrate a response, which seemed unlikely considering my extensive coughing fits, or the underlying issue might be irreparable with medications. This situation has left me anxious that I may be dealing with more than just severe asthma. For years, I communicated to my doctors that my condition seems to deteriorate, and that none of the prescribed medications eased my cough, yet they continuously reassured me that it was manageable. Now, after being hospitalized, I recognize the critical need to take this seriously. I rarely experience wheezing or fluid but instead contend with a persistent cough similar to that of a long-term smoker. My cough worsens with movement, eating, drinking, taking deep breaths, lying down, waking up, laughing, excessive talking, exposure to extreme temperatures, dry or humid air, stress, and irritants such as dust, smoke, and potent odors. It feels like merely existing prompts my coughing. Although I always have a cough, the triggers mentioned intensify it. I frequently feel congestion in my throat and chest, accompanied by a tight and painful sensation. I have the incessant urge to clear out whatever feels obstructive, but nothing ever emerges. My coughing often leads to dizziness and incontinence. If I'm not actively coughing, I seem to be clearing my throat repeatedly to manage the mucus. During any illness, my cough tends to worsen, resulting in the need for prednisone. Antihistamines provide partial relief solely for nasal symptoms, without helping my throat and chest. When my rescue inhaler does work, its effectiveness lasts only for a short time before I revert to my previous condition. My lungs may feel momentarily unobstructed thanks to the albuterol, but the coughing inevitably returns until my chest aches again. An ER doctor suggested possible diagnoses of Chronic Rhinosinusitis, Post-Nasal Drip, or GERD; however, medications for allergies and acid reflux have not meaningfully addressed my coughing or breathlessness. It does not seem connected to my sinuses but rather feels like my airways are obstructed, hindering deep breaths. Until I meet with the pulmonologist, my best hypothesis has been Cough-Variant Asthma, but given the lack of response to bronchodilators in my PFT, my confidence in that is wavering. In reviewing my results, I cannot help but consider the early stages of COPD or emphysema, especially since my breathing seems to worsen over time, although my age typically mitigates those concerns given my extensive exposure. I've ordered a test for Alpha-1 antitrypsin deficiency from AlphaID to discuss with my pulmonologist just in case. I am certain I have asthma, but I’m beginning to suspect that there may be additional complications involved. For years, my primary care provider dismissed my concerns, despite my insistence that something felt off. It wasn’t until I required EMS intervention that she finally began the referral process to specialists. I find myself in a state of confusion and unease. Has anyone here experienced anything resembling my situation? I'm looking forward to consulting with the pulmonologist about my test results in the coming week or two, but I’m apprehensive that they will simply dismiss my concerns like previous practitioners have done.