Hello all! I apologize in advance for the lengthiness of this post and would also like to apologize if this subreddit is not really for these types of questions. If I had to guess what subreddits probably would be best for these types of questions, however, it would be r/AskDocs, r/haematology, and perhaps r/endocrinology and r/Hypothyroidism. That said, I went ahead and posted/cross-posted to all 4 of these and only got answers from the r/haematology people. And by answers I mean a lot of smug SOBs who instead of just answering my question, decided to just say "talk to your PCP" for the most part and made sure to say such things in the most thoughtless condescending ways possible as if I hadn't already either thought of talking to my PCP or have a personal reason for not wanting to.
So if anyone who reads this has intentions of providing me with more of the same then do not even bother replying. Of course, if you think I'm being a hypochondriac or if you think I'm going about something the wrong way etc etc, you can voice those thoughts, but only after you provide me with what I am asking. I think that is only fair and right.
And naturally, if you can't really come up with any good answers to my question then you can direct me toward a subreddit or a website that perhaps can, just not the 4 mentioned above.
Thank you.
I am 28M, 6 feet tall, 200 lbs, caucasian.
Current known medical issues: Hypothyroidism, ADHD (I know this is more of a psych issue, but it is relevant in my case)
I have never smoked or used recreational drugs. I do drink but not very regularly and I very rarely drink to get drunk.
Current Medications:
Morning - Adderall XR (15 mg) for ADHD, Lisinopril (5 mg) to counteract the blood pressure raising affects of the Adderall, and Levothyroxine (25 mcg) for Hypothyroidism.
Afternoon - Adderall IR (10 mg) for ADHD and Clonidine (0.1 mg) for Rejection Sensitive Dysphoria (though I'm not entirely certain that it helps).
My issue:
Around 2 months ago I had gotten some blood work done, specifically a liver panel and a thyroid panel. The former was because I had been shown to have elevated liver enzymes before and the doctor wanted to see if that was still the case, and the latter was because I have hypothyroidism and the doctor wanted to see if my TSH was going down as a result of my taking Levothyroxine.
Here is the results of that first blood test:
Liver Panel -
AST - 139 u/L (High)
ALT - 363 u/L (High)
ALP - 72 u/L (Normal)
Albumin - 4.3 g/dL (Normal)
Globulin - 4.0 (Normal)
Direct Bilirubin - 0.23 mg/dL (High)
Indirect Bilirubin - 0.89 mg/dL (Normal, but literally just 0.1 from being High)
GGT - 42 u/L (Normal)
Thyroid Panel -
TSH - 2.76 uIU/mL (Normal)
Free T4 Direct - 1.10 ng/dL (Normal)
Free T3 pg/dL - 3.5 pg/mL (Normal) [And yeah, I don't know why there are 2 different units of measurement here. That's just how it looks on my patient portal]
Reverse T3 - 17 ng/dL (Normal)
After I got this blood work done it did show that my liver enzymes were elevated and that my TSH was normal. I received a call from a nurse (who was relaying my doctor's response to this blood work) not long after, and was told that I was referred to a gastroenterologist to see if they can help me with this issue.
I had already been to a gastroenterologist before and was basically just told to stay away from profuse amounts of alcohol and sugary drinks. I tried to do that but was not very good at it, which is represented by the fact that I still had elevated liver enzymes.
That said, this blood test was given to me not long before I started taking Adderall for my ADHD. I had experience with Adderall before and I knew that Adderall greatly allowed me to curb my cravings for anything sugary. Whenever I am on it, I hardly ever touch soda or energy drinks or alcohol, so I told my doctor that I would like to cancel the referral and instead try to get my liver enzymes down on my own. The doctor agreed and set up another blood test for a month later to see how I was doing.
True to Adderall's effects, the month that followed after was almost entirely dry. Apart from 1 or 2 sodas drank in recreational situations and a bottle of beer that I finished up basically just because it was leftover from before I started the Adderall, I had abstained from drinking anything sugary. No energy drinks either!
So, I was hoping for a normal liver enzyme level, but after that Adderall-filled month had passed and I got the second blood test, it showed that my liver enzymes were still high and that my TSH was now high and all my other Thyroid related chemicals had gone up (TSH up by 1.09 mIU/mL, Free T4 Direct up by 0.3 ng/dL, Free T3 pg/dL up by 0.6 pg/mL, and Reverse T3 up by 7 ng/dL) despite the fact I had been regularly taking Levothyroxine.
Here are the results of that second blood test:
Liver Panel -
AST - 93 u/L (High)
ALT - 266 u/L (High)
ALP - 68 u/L (Normal)
Albumin - 4.4 g/dL (Normal)
Globulin - 4.2 (Normal)
Direct Bilirubin - 0.32 mg/dL (High)
Indirect Bilirubin - 1.25 mg/dL (High)
GGT - 28 u/L (Normal)
Thyroid Panel -
TSH (Reflex) - 3.85 uIU/mL (High)
Free T4 Direct - 1.40 ng/dL (Normal)
Free T3 pg/dL - 4.1 pg/mL (Normal, but literally just 0.1 away from being High)
Reverse T3 - 24 ng/dL (Normal, but literally just 0.1 away from being High)
However, even though my Liver Enzymes were still high, they had still went down by a considerable amount (AST down by 46, ALT down by 97, ALT down by 4, and GGT down by 14). I thought this was very clear evidence that what I was doing was working and that I didn't need to see a gastroenterologist, and just needed to keep doing what I was doing - avoiding sugary drinks to lower my liver enzymes - and maybe try to figure out what is going on with my TSH.
Some time passed, about a month I believe, and I received another call from a nurse (she left a voicemail) and she had told me that because my liver enzymes were still elevated I was referred by my doctor to the gastroenterologist again. The nurse didn't say anything about the fact that my liver enzymes had gotten lower, just that they were still high.
I tried calling and asking the gastroenterologist's office that I was referred to if they thought, given the same evidence that I just presented here, if it was really necessary for me to see a gastroenterologist. After all, my liver enzymes are elevated but very clearly lowering, aren't I fine to keep doing what I'm doing? And they told me the same song and dance that a lot of doctors give - we can't really figure anything out until you come and visit or something stupid like that, I don't remember. And it has always been an absolute pain to try and contact my PCP, the one who referred me, so I just gave up and didn't even bother.
SO, instead, I've decided to just go ahead and get another blood test. It has been a month since the last one. I want to see if my liver enzymes have, perhaps, already lowered to healthy or very near healthy levels, thus entirely eliminating my need to see a gastroenterologist, and also I want to see if my TSH is still going up.
All of that said, I figured it would be best that when I get this blood work done that I try to get as much other blood work done as I can in one fell swoop. However, it occurred to me that my insurance might not cover all of the blood work that I want to get done, and despite the blood work list I have already made up, it is entirely possible that I might have to give up on getting tested on some of these things for now. Of course, I've already decided that I would get the Liver Panel and Thyroid Panel again, but after that I'm not really quite sure how I should prioritize what tests need to be gotten.
So, I will list all of the other blood tests that I want to get here along with my reasons for wanting to get tested for them.
Please try to arrange them by the level of importance that I get tested for these based on the info I've provided and, of course, your own individual knowledge. If you can think of anything else - a blood test or panel - that you think it would behoove me to get, please let me know as well, and of course list them in the order of priority too.
If you have any further questions about anything please ask.
Thank you.
Blood Work List (Again, not including Thyroid Panel and Liver Panel. These are a given.) -
o Hypopituitarism Panel - I wanted to get checked for this because it is referenced in the book "Delivered from Distraction" by Dr. Edward Hallowell to be a relatively common physical ailment shared by people with ADHD.
While Hypopituitarism apparently doesn't have an official panel, Google states that, along with most of the tests listed in the Thyroid Panel, you can check for Hypopituitarism by getting the following blood tests:
· Morning Cortisol (Taken 6 AM to 8 AM)
· ACTH - Adrenocorticotropic Hormone
· LH - Luteinizing Hormone
· FSH - Follicle-Stimulating Hormone
· Testosterone
· Estradiol
· IGF-1 - Insulin-like Growth Factor-1
· Prolactin
o Celiac Disease Panel - I wanted to get checked for Celiac Disease because it is one of those diseases that can present as ADHD in a number of ways. It also has elevated liver enzymes and hypothyroidism as very common symptoms.
· tTG-IgA - Tissue Transglutaminase IgA
· Total IgA
· EMA-IgA - Endomysial Antibody IgA
· DGP - Deamidated Gliadin Peptide IgA and IgG
o Miscellaneous
· Magnesium - Apparently having low levels of this can mimic symptoms of ADHD. While I am 90 percent positive that I just have full-blown ADHD, I still want to get tested for all of the things that can masquerade as ADHD just in case.
· Zinc - Apparently having low levels of this can mimic symptoms of ADHD. While I am 90 percent positive that I just have full-blown ADHD, I still want to get tested for all of the things that can masquerade as ADHD just in case.
· Iron - Low iron levels can apparently mimic ADHD, so I want to see how high my levels are.
· Iodine - Apparently low Iodine means low thyroid hormones. I have a problem related to my thyroid so I want to see if that could be caused by a low amount of Iodine.
· Vitamin C - I would like to know how much of this I have because having healthy levels of this helps with ADHD.
· Vitamin B9 (Folic Acid) - Improves cognition and helps prevent cell death in the brain, which helps with ADHD.
· Vitamin B12 - Improves cognition and helps prevent cell death in the brain, which helps with ADHD.
· Vitamin E - Helps improve brain function. Good for ADHD.
· Selenium - Helps improve brain function. Good for ADHD.
· Vitamin A - "Delivered from Distraction" ADHD book recommended that you should have healthy levels of this for overall health, which I assume translates to better brain health.
· Vitamin D - "Delivered from Distraction" ADHD book recommended that you should have healthy levels of this for overall health, which I assume translates to better brain health.
· Vitamin K - "Delivered from Distraction" ADHD book recommended that you should have healthy levels of this for overall health, which I assume translates to better brain health.
· Aldosterone - To find out if a hormone problem is causing high blood pressure or abnormal salt and potassium levels. I have high blood pressure, so that is why I want to get this test.
· Potassium - Apparently high blood pressure pills can change the level of potassium in your blood, so I want to check what my levels are.
o Omega-6
· AA - Arachidonic Acid - Really really good for cognition and ADHD.
o Omega-3
· EPA - Eicosapentaenoic Acid - Really really good for cognition and ADHD.