Hi,
I would be interested in the ophthalmologist’s / endocrine clinical findings, esp. in relation to the two mentioned findings and also for any proptosis. I have not come across such a presentation, as these are subtle clinical signs of thyrotoxicosis found on clinical examination unless the patient has an obvious proptosis. In the latter case this could be Graves' orbitopathy which can present in isolation. The suppressed TSH is in line with this, the low FT4 is difficult to explain but you need further checks and monitoring. The thyrotoxic phase of sub acute ‘viral’ thyroditis is usually short and would not have expected significant eye signs. In the resolving phase I would expect the TSH to return to ‘normal’ or even slightly raised. TSI (TRAB) result would be of interest.
rgds
A
Dr Ahmed Waise FRCP FRCPath
Consultant Chemical Pathologist
Laboratory Medicine & Centre for Diabetes and Endocrinology
York Hospital,
YORK YO31 8HE
Tel 01904 72 5670
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____________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Asila Al-Musheifri [[log in to unmask]]
Sent: 21 February 2010 07:34
To: [log in to unmask]
Subject: Mysterious TFT results
Dear all,
We need help in these set of results
An 18-year-old male presented to the ophthalmologist with lid retraction and
lid lag. Physical examination hasn’t been done. No H/O any medical disorder
and he is not on any medication. His TFT results were measured on Elecsys
2010:
TSH < 0.005 (0.27-4.2 µIU/mL)
FT4 10.2 (12-22 pmol/L)
FT3 4.6 (3-5.9 pmol/L)
Repeated TFT on Architect to eliminate any possibility of interference:
TSH < 0.003 (0.3 - 4.3 mIU/L)
FT4 7.8 (8.4 -22.6 pmol/L)
FT3 3.8 (3-5.9 pmol/L)
Other hormone were measured ;
FSH 3.4 (1-8 IU/L)
LH 2.3 (2-14 IU/L)
PRL 168 (21-360 mIU/L)
And anti- thyroid peroxidase antibodies were 16 IU/L (< 10 negative)
What do you think about such results ? and what further tests/actions will
you do?
Regards,
Asila Al-Musheifri
Chemical Pathologist
Oman
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