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I have recently seen a young Caucasian girl, aged 20 years. Her family physician has referred her with persistently raised T3. She does not have any hyperthyroid symptoms at all and on other systemic enquiry she is asymptomatic. Her mother confirmed that she had a normal birth and normal childhood and pubertal developments, both physically and mentally. Physical examination was unremarkable.There is no family history of any thyroid related problems. The lab tests for the thyroid are as follows :
| August 2005 |
| FT3 -----8.72 pmol/l (2.67-7.03) FT4------12.9 pmol/l (10.3-24.5) TSH 2.39 mU/l ( 0.4-4.00 ) Anti TPO antibody 43.3 IU/ml (0.0-35) |
| May 2005 |
| FT3------8.17 pmol/l FT4------20.3 pmpl/l TSH 0.24 mU/l |
| April 2005 |
| FT3 ------8.76 pmol/l FT4------19.4 pmol/l TSH--- 0.11 mU/l |
I am wondering if she has thyroid hormone resistance.In absence of symptoms, how may I manage her? Should her family members be screened as well? Does she need any imaging of her pituitary gland to look for an adenoma? (TSHoma?)
Dr. Sagarika Mukherjee.
Response
More likely she has Hashimoto's thyroiditis and has at times had mild T3 toxicosis. I would follow her without treatment, at the moment. A standard test for GRTH is given in www.thyroidmanager.org, but I doubt that she needs it unless new problems arise I dont think she needs pituitary imaging. Testing her family for thyroid antibodies might be of interest, but is not neccessary.
Leslie J De Groot, MD