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.