# Lab Results, ADHD Stimulants skewing results?



## andyb1205 (Aug 29, 2016)

I will be following up with the Endocrinologist tomorrow, it will be our second meeting. In our first meeting he was unsure if I have a thyroid problems but suspected adult growth hormone deficiency. I shared an article on how GH deficiency can mask subclinical/mild Central hypothyroidism and was hoping my tests can point to that.

TSH has always been in range, from just under top of range a few years ago to right in the middle (2.5ish) to just barely in the range, Free T4/Free T3 remaining throughout in bottom tertile. My personal self diagnosis through the years shifted from subclinical hypothyroidism to being convinced I have Central hypothyroidism (recent evidence shows TSH here can be low, normal or even slightly elevated leading to misdiagnosis). Antibodies in range over the years.

I had the pituitary function tests and everything came back normal. GH test was less than 0.1 (deficient being less than 3.0) but IGF1 came back normal! Maybe he will run further tests to check for GHD. Vitamins are all fine, B12, Iron, Vitamin D (supplementing).

On 112mcg Synthroid.

TSH 0.38 (0.32 - 5.04)
FT4 13.3 (10.6-19.7)
FT3 4.07 (3.00 - 5.90)
ALT 70 (less than 50)
AST 35 (less than 36)
CK in range

Testosterone 14.6 (8.4-28.8) low-normal (normal for an 80 year old from what I've read, not a 27 year old)

Celiac ruled out. Internist ran a bunch of tests to check for inflammation, all good. Did hydrogen breath test, suggestive of bacterial overgrowth which research suggests can come from slowed motility and hypothyroidism.

Interesting thing to note, my TSH had dramatically dropped from 2.5 to barely in range (around 0.50) after beginning Adderall, currently on Vyvanse. Drop in TSH did not in return increase FT4. For those with normal HPA axis, log TSH vs FT4 on a graph shows an inverse relation, a decreasing curve. For me, it's a bunch of random zigzags.

From a scientific journal:

"Dopamine agonists and similar agents (table 1) can acutely suppress thyrotropin levels to lower-than-normal but detectable values.3 In patients with true hyperthyroidism, thyrotropin levels are often undetectable. Amphetamines also transiently increase dopamine release for between 1 and 3 weeks."

After 8 months, it seems like the amphetamines unmasked problems in HPA axis. Crossing my fingers that the doctor not only runs further tests on growth hormone deficiency but agrees to dose me according to the actual thyroid hormones. Because because I've ran all the tests and at this age the physiotherapist mentioned I have hypotonia, carpal tunnel syndrome, and peripheral neuropathy. Without socks as a cushion I walk with a limp because of soreness on my left foot. My younger brother has similar physical weakness, we've always been weaker than our peers. He will be seeing the same endocrinologist for the first time next week, his TSH is also normal (1.78) with FT4 in bottom tertile, never tested FT3 yet.


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## andyb1205 (Aug 29, 2016)

GH test came back fine, while pituitary fine. But Endo dismissed that my problems are thyroid related. When I mentioned I did not change my lifestyle the two times I had massive weight gain, 150 to 220 at age 18, 185 to 225 when taken off thyroid meds a year and half ago, he said that from his experience it’s usually a case of patient denial about their lifestyle. Recommended I see a dietician and record what I eat.


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## Lovlkn (Dec 20, 2009)

> On 112mcg Synthroid.
> 
> TSH 0.38 (0.32 - 5.04)
> FT4 13.3 (10.6-19.7) *((15.15-17.425))*
> ...


If we are just talking thyroid... your Free's are fairly low. I've edited in bold the 1/2-3/4 range within the range. Based on the "free's" you are in need of more thyroid hormone supplement, however, I bet your doctor is concerned with your TSH thus will not increase hormone supplement.

What are your TPO antibodies and have they ever run TSI on you?

Any explanation as to why your liver enzymes are elevated?


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## andyb1205 (Aug 29, 2016)

TSI was ran almost a couple years ago and was fine, <0.9 (<1.8).

TPOab has been fine over the years, last year the few times it was run it was 12, 18, 13, and 16 in range <35. Been around the same since 2014.

My TSH had dropped from 2.19 to 0.50 (0.32-5.04) 9 months ago and has been around the same on doses 75, 88, 100 and now 112mcg Synthroid. That was when I started stimulant medication for ADHD. But while I've read dopamine agonists can lower or suppress TSH, amphetamines are only supposed to transiently decrease it, only for the feedback loop to restore the TSH to what it was before.

The Endo just said that the interference of the amphetamines is fine because TSH has been stable, yeah, stable around 0.50 on doses between 75 to 112 but he didn't care to look at the FT4 which was more indicative of how I felt. I felt bit hyper when FT4 was 78% in range but now it's been lower and I feel hypo despite TSH still being low throughout.

The TSH is lowered by interference of the amphetamines I bet. By the way the Endo said he doesn't think I have an endocrine problem and will send my GP recommendation on treatment. I'm afraid he told him to take me off Synthroid altogether, will find out Sunday.


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## andyb1205 (Aug 29, 2016)

A bit anxious to see what the doc says. I have so many hypo symptoms but not sure what the cause is.

After I was taken off the thyroid meds by a negligent doctor for like 8 months, with the return of so many hypo symptoms, my TSH was only around 2.50, and Free T4/T3 were in bottom tertile. Hashis without antibodies is rare, but my brother also has many hypo symptoms with TSH of 1.78 and Free T4 in bottom fertile.

Will ask my doctor if he can dose me according to FT4 with a referral for a second opinion, there's an Endo here who is posted on this top thyroid doctors website. I'm also considering paying for private genetic testing panel with Blueprint Genetics to factor our rarer causes, that's how desparate I am.

Lovlkn, sorry I forgot to answer why my liver enzymes are elevated. I am having an ultrasound of the abdomen done in a couple days, a year ago they said I have borderline fatty liver so it could be that. I suspect it's related to being hypo.


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## Hopeful (Apr 10, 2018)

Hi Andyb1205,

TSI is a Graves antibody or relates to Hashitoxicosis, which is not Hashimoto's. The other Hashimoto's antibody is called TG/ab. Did you test TG?

You are quite hypo with your levels. It's your much too low FT3/4 that are a concern, not the low TSH. In the past, when your TSH was 2.50, 2.50 TSH is getting up there, so it's not really at an "only" level. Plus you had had bottom level FT3/4, so are hypothyroid. When you are hypo, your metabolism is too slow. Inability to process fats can be a results. Your liver enzymes are barely out of range. This could be caused by your diet. What all do you eat? Do you eat a lot of carbs by chance? Your supplements could also cause this. What are you taking? Do you eat sugar or drink alcohol?

ADHD are likely not the cause of anything here. You are hypo with your low FT3/FT4. Hypo isn't based on TSH, it's based on your thyroid hormones T3 and T4 and your symptoms. I've taken a very lose dose of adderall for years, but not every day. It's never interfered with my thyroid levels.

The weight gain and weight loss often happens as the thyroid is going between hypo and hyper as it is starting to struggle to produce the right levels of thyroid hormones before it permanently ends up hypo. Thyroid antibodies can increase over time in the right conditions and then you'll have Hashimoto's, so testing is every so often is still important. All of us with Hashi's didn't have it at one point, and then it developed. It does not develop over night and it's important to catch it early on. My antibodies did not get to over 1000, as they were when I was finally diagnosed. Just a few months later and after no medication, they were up into the multiple 1,000's. Once they get that high, it is about impossible to ever lower them. The lowest mine have ever been since diagnosis was 1000 last summer. I really wish this would have been caught in a timely manner.


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## andyb1205 (Aug 29, 2016)

Hi thanks for the kind reply. My TGab was tested last year, in range at 14 (less than 40).

I understand the importance of thyroid hormone levels but the doctors, even the Endo I saw, are clueless about it. Especially more difficult is that they don't think that low-normal T4/T3 is significant, even in presence of hypo symptoms.

The reason I mentioned the drop in TSH after beginning stimulants for ADHD is that, if the Hypothalymic-Pituitary-Thyroid axis is working correctly, the drop in TSH is supposed to only be temporary. Important to note that the stimulants did not affect the thyroid hormone levels, something I pointed out to the doctor only for it to fly over his head! Will an ultrasound of my thyroid better show if I have Hashis?

Regarding the liver, I haven't drank alcohol in 9 months, in fact my enzymes were lower when I did all those years! The only supplement I take is Vitamin D. I do eat sugar, like maybe 4-5 biscuits a day, not including fruit. I think the food just isn't getting metabolized properly because I'm hypo. I will get back to dieting and exercise soon, just been so demoralized since the slowed metabolism made it hard to see any results in past experiences so I didn't see the point.


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## andyb1205 (Aug 29, 2016)

Just an update. Had my labs drawn recently, on 112mcg Synthroid.

TSH 0.26 (0.32-5.04)
FT4 14.0 (10.6-19.7)
FT3 4.05 (3.00-5.90)

Both FT4/FT3 are just a bit over third of range. I explained to the doctor I know what hyper symptoms are, many months ago I felt some hyper symptoms correlating with FT4 in 78% of range (unaware of interaction I took Adderall and Synthroid in same mouthful at the time). And that I clearly am feeling hypo, with stimulants artificially lowering TSH without HPT axis increasing the TSH as it should according to the literature (interference should be transient, not permanent as its been 8 months in stimulants!)

He will get me to do a thyroid ultrasound (TPOab was 18 <35 last year). We agreed to retest TSH, T4 and T3 around 4 weeks after reaching a stable stimulant dose (currently tottering) as it affects increased absorption of thyroxine. Sounds fair, will see how it goes.


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## Lovlkn (Dec 20, 2009)

> FT4 in 78% of range


When my FT-4 is that high I also suffer from hyper symptoms. Have you considered alternating days or simply not taking 1 day a week and staying on the 50mcg?


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## andyb1205 (Aug 29, 2016)

Hey Lovlkn, sorry I think you misread! My frees now are currently suggestive of hypo, barely over third of range. I only brought up when my FT4 was 78% of range many months ago to show the doctor my TSH seems to be inaccurate and not responding to changes in FT4.

Anyways, it's been puzzling to me and my doctor why my HPT axis isn't working properly ever since I began stimulants for ADHD 10 months ago. So I am having an ultrasound done to check for nodules so we can get more information.


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## Lovlkn (Dec 20, 2009)

Sorry about that! Had a tough morning waking up today.

The ultrasound sounds like the best option to determine if nodules might be involved.


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## andyb1205 (Aug 29, 2016)

No problem! Yeah I have the ultrasound this Friday so hope to get answers. I should've had one done a long time ago, but I respect this doctor caring enough to get to the bottom of this.

Perhaps you have some sources to read or can help me understand this. What's the relation between nodules and Hashimotos, and can nodules interfere with the thyroid axis? I have noticed I felt a more tightening in my neck on lower doses and more importantly with lower Frees.


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## andyb1205 (Aug 29, 2016)

Got my ultrasound results, still no idea what the heck hit my thyroid hormones if not Hashimotos. Ugh. Results:

The right lobe measures 38mm in length and the left measures 37mm. The isthmic region measures 3mm.

No cystic or solid masses of other thyroid abnormalities detected.

Normal bilateral lymph nodes noted.

All other findings are unremarkable.

Summary: Normal thyroid ultrasound.


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## Lovlkn (Dec 20, 2009)

WOW! That's interesting - although with low antibodies not actually. Was almost hoping for a nodule or 2 to help explain your issue - hmmmm.

Low labs that can contribute to hypo like feelings are:

Vitamin D

B-12

Ferritin

While your labs are still on the hypo side, have you ever had any of the tests I just mentioned?

Might be worth a shot as addressing anything that contributes to hypo signs might help how you feel.


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## andyb1205 (Aug 29, 2016)

My Ferritin has always been good and in the triple digits, only recently it was 75 but probably related to diet. Will get that rechecked along with Serum Iron, but only relevant to how I feel now not all those years.

I had a Vitamin D deficiency for God knows how long, but since it's discovery 2 years I have been supplementing. Couple months ago was barely in range, have been on a loading dose of 10,000/day (70,000/week) ever since.

B12 is something I'm unsure of since supplements could've interfered most of the times I had it checked. 2 years ago it was barely in range, few months ago (had discontinued supplements months earlier) was bit over range. Need to recheck in case the the supplements were still in my system at the time.

It is possible that when my TSH had hit 5.30 and 4.20 8 months apart in 2013-2014 (with 4.20, FT4/FT3 were 36%/24%) I had Vitamin D deficiency. B12 was 460, unsure if multivitamin affected that. However, while fixing my Vitamin D deficiency and taking B12 and B-Complex in 2016 over 8 month period off of NDT, TSH stabilized at 2.50 but FT4/FT3 only stabilized at less than third of range.

Have gotten tested for different STDs, good. I have a fatty liver but that's a chicken or egg question with the thyroid, I assumed it affects T4 to T3 conversion not production of T4.

I want the ultrasound to be false but it's more likely it's not. Best option I have IMO is to ask my doctor to dose me according to my FT4/FT3 while I am waiting to see the Endo. I have a referral for a second opinion, this Endo prescribes T3 and is recommended on a thyroid patient website.

https://www.ratemds.com/doctor-ratings/88110/Dr-David+M.-Thompson-Vancouver-BC.html


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