This is a case where a binding protein increase could show up in the total T3 assay, but not in the free T4 assay. Given that free T4 and fT3 are 'normal', all we aer left with is a low TSH, which is not that uncommon. I would not pursue this sort of case in great detail, after demonstrating that free T3/T4 were within reference range. I would, however, suggest that she is followed up, as being 'at risk' of future hyperthyroidism, with low TSH. (I say this as a non-medic, and am open to criticism by medically-qualified colleagues!)
Cathryn Corns
-----Original Message-----
From: Grimes, Helen, UCHG [mailto:[log in to unmask]]
Sent: 30 December 2002 17:20
To: [log in to unmask]
Subject: Summary of our elevated T3 patient, who now has a normal Ft3
63 year old female presented to GP with diarrhoea and weight loss,ft4 17.8
pmol/l, TSH <0.02 m|U/L, T3 3.2 nmol/L. Three weeks later, diarrhoea has
since cleared and patient is putting weight back on, ft4 20.0 pmol/l, TSH
<0.02 m|U/L, T3 3.9 nmol/L. On file was a set of results from 1997 ft4 19.3
pmol/l, TSH <0.02 m|U/L, T3 3.0 nmol/L. GP says patient is not on HRT, not
the type to take herbal remedies etc.
Follow up was a Free T3 of 5.1 (Ref Range 2.8-6.5) TPO antibody <10.
Thanks for the suggestions of using different methods. Our Bayer/Centaur Ft4
and TSH results were similar on Immulite. The easiest way out is to say
elevated T3 is not supported by FT3, and just recheck the patient in 6
months time, unless earlier checking is clinically indicated. I base this on
the fact that an "elevated" t3 was noted in 1997, and the recent loss of
weight does not appear to be thyroid related. Would many laboratories chase
this ambiguity until they would solve it?
____________________________________________________________
Dr. Helen Grimes, Dept. of Clinical Biochemistry, UCH, Galway, Ireland
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