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Elevated liver enzymes?

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Elevated liver enzymes?

Posted By
2/10/2020 1:03pm
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Replies: 6


As some may have followed, I developed hypothyroidism after my third ipi/nivo treatment. for stage IV melanoma (mets in liver and lungs) I'm taking meds for it now.

My nurse said that my liver levels are elevated, but not enough to be too concerned about yet. Just wondering if anyone knows when I should become concerned?

My ALT at last test was 51 U/L. It's crept it's way up from 17 to 51 over the last four months.

My AST at last test was 49 U/L. It's crept it's way up from 22 to 49 over the last four months.

Any weigh in on when I should be concerned would be great. I go for my scans Saturday and am hopeful for good a good response!


Primary 1B in 2014 - WLE and SNB negative. Recurrence Dec 2019 - Stage IV with mets in liver and lungs. Currently on ipi/nivo combo @ MD Anderson (Houston, TX).

ed williams - (2/10/2020 - 2:13pm)

Hi Jennifer, so they have four grades with grade one being the lowest or least dangerous. If you go to "Immune related hepatotoxicity" in following link open up figure 7 in new window and blow up image you will see grade 2, is 3 to 5 times (x) ULN ( upper limit normal) and then grade 3 which is 5 to 20 ULN and finally grade 4 greater than 20 times Upper limit of normal. I hope this helps!!! Ed

MelMel - (2/11/2020 - 7:42pm)

Ed is correct with the grades. The day of my 3rd combo infusion, my AST was 119 and ALT 157 and my oncologist refused to give me my 3 rd infusion. Three weeks earlier both values were well below normal (AST less than 30 and ALT equal or less than 35). Within a week after what would have been my 3 rd infusion, my AST was 167 and AST 260. Two days later, my AST was 363 and AST 434. Off to the hospital I went and this was followed by two one week hospital stays plus months of high dose steroids including an organ rejection drug. Basically, things change rapidly once liver injury occurs. Hopefully, you have an easier time.

MelMel - (2/13/2020 - 9:51pm)

That should have read ALT 260 and ALT 434.

AMcReader - (2/11/2020 - 10:20am)

Hi Jennifer, If your doctor isn’t concerned, I wouldn’t be concerned. If it gets too high they can always get you on steroids to calm everything down.

For reference, my ALT and AST went CRAZY after my third dose of Ipi/ ALT shot up to 2600 (no, that’s not a spare extra zero). I ended up in the hospital for 5 days and was on steroids for months but everything is back in range now.

Take care!


Stage IV — one brain met (resected via craniotomy 3/1/18 and subsequently treated with SRS) and two lung mets. Started Opdivo 4/16/18. Opdivo not eliminating lung mets, so on 12/5/18 started Ipi/Nivo combo.

DoubleTT - (2/11/2020 - 10:18pm)

Hi there Jennifer
I had the same thing we I was on Opdivo. I had lost my Thyroid to thyroud cancer in 2011 so was already on Synthroid high dose meds. Fast forward to 2016 and I get melanoma. Half way through Opdivo liver enzymes were going up. Smart docs at Princess Margaret Cancer Centre in Toronto Canada did a bunch of extra thyroid testing my free T4 numbers were climbing way too high which makes the liver go crazy. So we set a course to get my TSh FreeT4 T3 numbers where they should be and voila! my liver was happy again. I also was banned from Tylenol. Some peeps on Opdivo have issues with liver enzymes if taking a lot of Tylenol. Hope this helps...Hugs Tracey

<p>Double TT- Toronto Canada</p>

Tsvetochka - (2/13/2020 - 4:41am)

I have had elevated liver enzymes a few times. I don't remember the exact numbers offhand. My doctor has me take a round of liver support medicine and some supplements, and it goes back down.

Stage 4 in April 2019, NED from April 2020, thanks to Keytruda and lots of prayer!