A 19-year-old girl complained of anxiety and excessive sweating. She was not taking any medication.
Investigations showed:
TSH concentration 0.9 mU/L (0.5-3.4)
free T4 concentration 16 pmol/L (10-18)
total T4 concentration 180 nmol/L (55-145)
free T3 concentration 8.2 pmol/L (3.5-10.5)
total T3 concentration 3.3 nmol/L (0.9-2.5)
These results are compatible with which one of the following diagnoses?
A) Factitious thyrotoxicosis
B) Familial dysalbuminaemic hyperthyroxinaemia
C) Pregnancy
D) Sick euthyroid syndrome
E) Thyrotoxicosis
Answer:
C Pregnancy
Discussion:
The symptom complex is intentionally misleading. The patient has a normal TSH and normal free T3 and T4 concentrations, excluding thyrotoxicosis but elevated Total concentrations suggesting a rise in the binding globulins. This can occur in pregnancy.
Sick euthyroidism would be typically associated with low thyroid hormone concentrations.
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