Dear Doctor Mark:
Based on the info below, my main questions are:
1. In your opinion, could this be Graves disease? What points toward/against a Graves diagnosis?
2. Do most Endos consider the TSI test definitive for Graves even if levels are less than 125%? What is your opinion on that?
3. I've read some medical literature that dopaminergic agents can affect thyroid hormone tests. Is it possible that the medications I've taken longterm (Wellbutrin and Adderall, both of which affect dopamine) might be skewing my lab numbers?
History of depression (10+ years); Dx w/Adult ADD (~5 years); carpal tunnel (surgery, both hands); periodontal disease/infection.
Daily Rx meds: Wellbutrin-XL 30 mg; Adderall-XR 20 mg.
Family history heavy in thyroid disease and autoimmune disease, including hypothyroid, Graves, Lupus, CFS, MS, Rhuematoid Arthritis.
Patient symptoms: goiter (painless), fatigue, low energy, low libido, dry skin, mild hair changes, pretibial rash (past 2 years), recent menstrual changes (lighter flow), irritability, insomnia (trouble falling asleep), recent itchy hives-type rash on torso (past 6 weeks).
Complex cold nodule on left lobe, 1.9 x 2.8 cm.
FNA: "benign colloid adenomatoid nodule"
RAI-U (range 15-30%): 6-hr 8.9% (below normal); 24-hr 19.6% (within limits but low-normal)
All thyroid hormone tests are Euthyroid. Please see below for Lab Test results; note Iron deficiency.
Sorry post is so long. Thank you for your opinion!