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Free thyroxine (fT 4 or free T4) is generally elevated in hyperthyroidism and decreased in hypothyroidism. [2] Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are:
Stress suppresses TSH, [5] and alterations in thyroid hormone levels may arise in psychiatric illness. In major depressive disorder, an NTIS-like phenotype may be observed, with reduced T3 and increased rT3. T4 may be elevated, and TSH is usually normal, although TSH's normal circadian rhythm may be disrupted. [2]
Subclinical hypothyroidism is a biochemical diagnosis characterized by an elevated serum TSH level, but with a normal serum free thyroxine level. [47] [48] [49] The incidence of subclinical hypothyroidism is estimated to be 3-15% and a higher incidence is seen in elderly people, females and those with lower iodine levels. [47]
Free T4 and total T3 can be measured when hyperthyroidism is of high suspicion as it will improve the accuracy of the diagnosis. Free T4, total T3 or both are elevated and serum TSH is below normal in hyperthyroidism. If the hyperthyroidism is mild, only serum T3 may be elevated and serum TSH can be low or may not be detected in the blood. [14]
In addition to testing the TSH levels, many doctors test for T 3, Free T 3, T 4, and/or Free T 4 for more detailed results. Free T 4 is unbound to any protein in the blood. Adult limits for these hormones are: TSH (units): 0.45 – 4.50 uIU/mL; T 4 Free/Direct (nanograms): 0.82 – 1.77 ng/dl; and T 3 (nanograms): 71 – 180 ng
Any inappropriateness of measured values, for instance a low-normal TSH together with a low-normal T 4 may signal tertiary (central) disease and a TSH to TRH pathology. Elevated reverse T 3 (RT 3) together with low-normal TSH and low-normal T 3, T 4 values, which is regarded as indicative for euthyroid sick syndrome, may also have to be ...
Thyroid's secretory capacity (G T, also referred to as thyroid's incretory capacity, maximum thyroid hormone output, T4 output or, if calculated from serum levels of thyrotropin and thyroxine, as SPINA-GT [a]) is the maximum stimulated amount of thyroxine that the thyroid can produce in a given time-unit (e.g. one second).
TSH is the preferred initial test of thyroid function as it has a higher sensitivity to changes in thyroid status than free T4. [61] Time of day can affect the results of this test; TSH peaks early in the morning and slumps in the late afternoon to early evening, [62] with "a variation in TSH by a mean of between 0.95 mIU/mL to 2.0 mIU/mL". [63]
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