Discrepant thyroid function test results in a 44-year-old man

DISCUSSION DIFFERENTIAL DIAGNOSIS The combination of goiter and increased concentrations of free thyroxine (T4)3 and free triiodothyronine (T3) with unsuppressed thyroid-stimulating hormone (TSH) is suspicious for 4 conditions: (a) hyperthyroidism with a false increase in TSH due to antibody interfe...

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Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 2013-12, Vol.59 (12), p.1703-1706
Main Authors: Leey, Julio, Cryer, Philip
Format: Article
Language:English
Subjects:
Adult
Antithyroid Agents - therapeutic use
Autoantibodies - blood
Blood pressure
Cardiac arrhythmia
Diagnosis, Differential
Family medical history
Hormones
Humans
Hyperthyroidism
Hyperthyroidism - diagnosis
Hyperthyroidism - drug therapy
Hyperthyroidism - physiopathology
Male
Muscle pain
Mutation
Older people
Patients
Pituitary gland
Propylthiouracil - therapeutic use
Surgery
Thyroid
Thyroid Function Tests
Thyrotropin - blood
Thyroxine - blood
Thyroxine - immunology
Tumors
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Summary:DISCUSSION DIFFERENTIAL DIAGNOSIS The combination of goiter and increased concentrations of free thyroxine (T4)3 and free triiodothyronine (T3) with unsuppressed thyroid-stimulating hormone (TSH) is suspicious for 4 conditions: (a) hyperthyroidism with a false increase in TSH due to antibody interference; (b) euthyroidism with a false increase in thyroid hormone due to antibody interference or abnormal binding to carrier proteins; (c) a TSH-secreting pituitary tumor; and (d) resistance to thyroid hormone. In patients with no clinical signs of hy- perthyroidism, discordance between thyroid hormone concentrations and TSH is highly suspicious for anti- body interference in either TSH or thyroid hormone measurement. The con- centration of serum sex hormone-binding globulin is increased in hyperthyroid states such as TSH-secreting pituitary tumors, whereas normal concentrations of this globulin are expected in patients with resistance to thyroid hormone (5).
ISSN:0009-9147
1530-8561
DOI:10.1373/clinchem.2012.202283