OpenHealth Q&A

Seeking Clarity on Health Concerns: Is It Time for a Second Opinion?

I am a 34-year-old woman who stands 5'9" and weighs 150 pounds. My current medication regimen includes 75 mg of Lamictal, 75 mg of Zoloft, and 20 mg of Adderall XR, taken approximately four times per week. I also use an oral contraceptive to manage my menstrual cycle and occasionally apply ketoconazole shampoo. I have been diagnosed with endogenous depression and generalized anxiety disorder, along with mild plaque psoriasis. I am currently in remission from Graves' disease, which led to a thyroid storm in 2017, resulting in pancreatitis that required hospitalization. During both of my pregnancies in 2017 and 2019, I experienced cholestasis, which led to being induced at 37 weeks. My primary concern lately revolves around my fluctuating liver enzyme levels. During my annual blood tests, my liver enzymes often show elevation, prompting me to return after two weeks for retesting, at which point the results usually normalize or nearly normalize. Over the past decade, my liver enzyme levels, including ALT, AST, bilirubin, and alkaline phosphatase, have been inconsistent. In 2024, my primary care physician conducted additional tests to search for a potential underlying cause. The results indicated that ceruloplasmin was elevated and alpha-1 antitrypsin was marginally high, while other tests, including ANA and SMA for autoimmune diseases, yielded negative results, as did all hepatitis tests. My doctor speculated that my oral contraceptive could be contributing to these fluctuations, prompting a referral to a gastroenterologist for further evaluation. I met with the gastroenterologist, and my liver enzyme levels were normal during that visit. However, he suggested monitoring my condition for the next six months. To my dismay, during the following appointment, I discovered that my enzyme levels were again elevated. The doctor even questioned the possibility of a lab error due to the erratic nature of the results. He subsequently ordered an abdominal ultrasound to rule out gallstones. I received the ultrasound results earlier this week, indicating that while there are no blockages or abnormalities, my liver is enlarged, measuring 20 cm. The gastroenterologist reached out to inform me that there is a diagnosis of mild hepatomegaly, and I should return in six months for a follow-up. However, to me, having a liver size that is substantially larger than normal does not seem 'mild.' I inquired about the possibility of discontinuing my oral contraceptive, and while he indicated he doesn't believe it is a significant factor, he left the decision up to me. Given my autoimmune disease history, the inconsistency in my enzyme levels, and the fact that around 20% of people with autoimmune hepatitis may test negative, could it be plausible that I am dealing with this condition? Should I pursue a liver biopsy for further evaluation, or is my anxiety playing a role in amplifying my concerns?

Answers (1)

6/28/2025, 8:20:42 PM

OpenHealth AI

It's understandable to feel concerned about fluctuations in your liver enzyme levels, especially given your complex medical history. Your liver is a vital organ, and knowing that you have mild hepatomegaly (enlarged liver) can naturally raise questions about your health.

Explanation

In your case, several factors could contribute to elevated liver enzymes, including:

1. Medications: Certain medications, including some oral contraceptives and psychiatric medications, can affect liver function. It's important to evaluate their potential impacts.
2. Autoimmune Conditions: Given your history with Graves’ disease and cholestasis, autoimmune processes might be relevant. Autoimmune hepatitis can sometimes present with negative serologies.
3. Monitoring and Diagnostic Strategies: Your gastroenterologist's suggestion to monitor the condition closely is common practice when liver function tests are inconsistent but not critically high.

Next Steps

1. Clarify Medication Impact:

   • Consider discussing with your primary care physician the possibility of changing or discontinuing your oral contraceptive in consultation with your gynecologist to see if it impacts your liver enzyme levels.

2. Follow Up on Hepatomegaly:

   • Stay on track with the follow-up appointments your gastroenterologist has scheduled. Since the liver is enlarged but without other abnormalities, yearly monitoring can help track changes.

3. Consider a Second Opinion:

   • If you remain uneasy about the diagnosis or the lack of comprehensive explanations, seeking a second opinion from another gastroenterologist can provide additional insights, which may help ease your concerns.

4. Liver Biopsy:

   • A liver biopsy can provide definitive information about the liver’s condition, including ruling out autoimmune hepatitis. Discuss the pros and cons of this procedure with your healthcare provider and see if it is a viable option considering your symptoms and lab results.

5. Monitor Symptoms and Anxiety:

   • Keep a journal of any symptoms, overall health changes, and feelings of anxiety. Tracking this information can help you communicate more effectively with your healthcare team and also reflect on whether your anxiety may be influencing your concerns.

You're doing well by actively engaging in your health management and seeking clarity. Maintain open communication with your healthcare providers on your concerns and preferences. This proactive approach will aid in confirming the best course of action moving forward. Please let me know if there's anything further.