Interesting case. Maybe biological potency of LT3 vs LT4 and intravenous route of TH administration could possibly account for such a suppression within 24 hours.
Incidentally was the patient also given steroids and/or inotropic support with dopamine? May have contributed to TSH drop.
Charlton
Dr Charlton Agius
BST Chemical Pathology
Clinical Chemistry
Pathology Department
Mater Dei Hospital, Malta
Ext: 2545 6370
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] on behalf of Mohammad Al-Jubouri [[log in to unmask]]
Sent: 09 August 2016 15:12
To: [log in to unmask]
Subject: [SPAM] - T3 therapy & TSH suppression - Number of numbers in MIME From exceeds maximum threshold
There is a belief that TSH requires at least 6 weeks to normalise/stabilise after starting/changing dose of thyroxine or lieothyronine replacement therapy.
We recently had a case of myxoedema coma with the following TFTs on admission:
FT4 4.4 pmol/L (Ref.11 - 22)
FT3 2.00 pmol/L (Ref. 3.1 -6.8)
TSH 68.1 mU/L (Ref.0.30 - 5.0)
Started IV T3 therapy 10 mcg every 4 hours and after 5 doses (50 mcg), TFTs were checked next day and were as follows:
FT4 3.7 pmol/L
FT3 5.4 pmol/L
TSH 15.3 mU/L
All results were double checked and are analytically accurate.
I consider this as a massive drop in TSH in response to 1 day of T3 therapy, is this what one would expect?
I would be grateful to your comments.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
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