35 year old male attends GP for check up - feeling fine, but aware that one
is supposed to visit GP on a regular basis. GP finds all well and sends us
blood for LFT, Lipids and TFT. "Odd" TFT, Ft4 checked for interference
following PEG precipiation, TSH checked in dilution, no interference found.
Checked with GP for unusual and usual medication, did not have any contrast
material etc, other medication other than on lysine (apparently being taken
prophylactically for herpes), so this is discontinued and further sample
submitted, and more tests carried out, ? Pituitary Tumour. Sent to another
laboratory for alternative method testing.
Bayer Centaur Roche Modular
Ft4 TSH TT3(DPC) fT3(elecy) TPO Bil Alk Phos ALT GGT
GH FSH LH Test
11/3/04 37.2 6.0 3.9 26 174(41-117)
42 55 0.6 3.5 5.0 44.9
5/4/04 33.0 4.0 2.6 <10
29/4/04 38.4 4.9 3.6 29 147
35 41
(Elecy) 45.9 4.5 11.0(3.5-6.5) 153(45-122)
So in summary, a well man with FT4/T3 and fT3 suggestive of hyperthyroidism,
but without TSH suppression, and in the background a slight elevation of
Bilibubin, Alk Phos and Testosterone. We hope to get blood from a brother to
check if the TFTs are genetic. Could abnormal thyroxine binding proteins
give such abnormalities without TSH suppression and clinical expression of
thyrotoxicosis. Any ideas on further investigations would be appreciated.
PS Our Bayer Centaur Ref range for Ft4 is 9-26 pmol/L, TT3 0.8-2.5 nmol/L,
TSH 0.3-5.5 mIU/L, Elecys fT4 is 11.5-23, TSH 0.35-5.5, Ft3 3.5-6.5.
_
_______________________________________________________
Dr. Helen Grimes, Dept. of Clinical Biochemistry, UCH, Galway, Ireland
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