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What Causes Elevated T4 Levels When Diagnosed With Hypothyroidism?
Question: Hi,
my wife was diagnosed with hypothyroidism in 2011 and has been on 50 mg of thyroxin since then. her t3 t4 were in control since three years but the recent tests suggested elevated t4 levels. I have attached the report. please let me know if I need to visit a doctor and what could high t4 means.
she started having heart palpitations and high bp since a week hence we got the test done.
my wife was diagnosed with hypothyroidism in 2011 and has been on 50 mg of thyroxin since then. her t3 t4 were in control since three years but the recent tests suggested elevated t4 levels. I have attached the report. please let me know if I need to visit a doctor and what could high t4 means.
she started having heart palpitations and high bp since a week hence we got the test done.
Brief Answer:
Thyroid
Detailed Answer:
Sorry to learn about your wife's bothersome symptoms.
Typically if the TSH is at goal, then it is fairly likely the thyroid status is ok.
Sometimes, the total T4 can be high if the TBG (Thyroid Binding Globulin) is high. This is the protein that carries the thyroid hormone in the blood circulation. Birth control pills, for example , can raise TBG. This leads to the blood test report for Total T4 to look higher than normal. Another situation where TBG increases is pregnancy.
In both these circumstances, as long as the TSH is at goal, one is not worried that things are abnormal.
So if I have a female patient who is not pregnant and is also not on birth control pills, then I order more tests to determine the cause. But commonly I order only Free T4 along with TSH because Free T4 is not dependent on TBG.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Thyroid
Detailed Answer:
Sorry to learn about your wife's bothersome symptoms.
Typically if the TSH is at goal, then it is fairly likely the thyroid status is ok.
Sometimes, the total T4 can be high if the TBG (Thyroid Binding Globulin) is high. This is the protein that carries the thyroid hormone in the blood circulation. Birth control pills, for example , can raise TBG. This leads to the blood test report for Total T4 to look higher than normal. Another situation where TBG increases is pregnancy.
In both these circumstances, as long as the TSH is at goal, one is not worried that things are abnormal.
So if I have a female patient who is not pregnant and is also not on birth control pills, then I order more tests to determine the cause. But commonly I order only Free T4 along with TSH because Free T4 is not dependent on TBG.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi doctor, thank you for responding. I am going to meet a doctor this Saturday. But would you advise continuing the 50 mg that she is taking now?
Brief Answer:
Follow up
Detailed Answer:
It should not be too problematic to skip the tablet for a couple days if she is feeling unwell especially with heart palpitations till the cause of the palpitations is explored.
Follow up
Detailed Answer:
It should not be too problematic to skip the tablet for a couple days if she is feeling unwell especially with heart palpitations till the cause of the palpitations is explored.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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