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Hyperthyroidism with normal serum total T4, T3, and thyroid binding protein concentration.

J F Caro, N G Sloane, J A Glennon

    Journal of Clinical Pathology
    |September 1, 1980
    PubMed
    Summary

    This study details a rare case of hyperthyroidism in a 60-year-old woman with thyroid binding globulin (TBG) deficiency. The findings suggest impaired peripheral conversion of thyroxine (T4) to triiodothyronine (T3) due to severe hyperthyroidism.

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    Area of Science:

    • Endocrinology
    • Thyroid Disorders
    • Metabolic Research

    Background:

    • Thyroid hormones, thyroxine (T4) and triiodothyronine (T3), regulate metabolism.
    • Thyroid-binding globulin (TBG) influences T4 transport and availability.
    • Hyperthyroidism involves excessive thyroid hormone production or action.

    Observation:

    • A 60-year-old woman presented with severe clinical hyperthyroidism.
    • She exhibited normal total serum T4 but elevated free T4 and T3 resin uptake.
    • Despite clinical signs, serum TBG concentration by immunoassay was normal, indicating a defect not affecting antigenicity.

    Findings:

    • Low-normal total and free serum T3 levels were observed.
    • A markedly elevated reverse T3 concentration was noted.

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  • These results suggest impaired peripheral conversion of T4 to T3.

    • Implications:

    • This case highlights a biochemical anomaly in thyroid hormone metabolism.
    • It underscores the impact of prolonged severe hyperthyroidism on T4 to T3 conversion.
    • Understanding such defects is crucial for accurate diagnosis and management of thyroid dysfunction.