Dear all
Any thoughts about this case?
We have a 70 y old woman recently referred to the Endocrine team. She has had very elevated TSH together with within range FT4 for years (results below). She was prescribed T4 replacement by her GP for some time but, eventually, she developed hyperthyroid symptoms and it was discontinued. She is clinically euthyroid and is not on any medication.
The sample has been analysed on different platforms (Abbott, Roche, Centaur and Delfia) with virtually identical results; blocking tubes and PEG do not suggest interference; serial dilutions are linear.
The picture gets more complex as she has elevated TPO.
TSH 96 mIU/L (0.35-3.50)
FT4 12 pmol/L (8-21)
TPO 321 kU/L (0.0-34.0)
TBG 24.8 (14 – 31)
Patients with inactivating mutations of the TSH receptor have mild TSH elevation normally. However, there are not that many cases reported and I suppose the TSH results depends on the degree of residual function of the receptor.
Any other thoughts?
Thanks and regards to all
Javier
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