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Free T4 levels should be measured in the evaluation of hypothyroidism, and low free T4 establishes the diagnosis. T3 levels are generally not measured in the evaluation of hypothyroidism. [13] Free T4 and total T3 can be measured when hyperthyroidism is of high suspicion as it will improve the accuracy of the diagnosis.
Older people should be started on lower doses of liothyronine. [12] Plasma T 3 concentrations in this population are decreased by 25% to 40%. [ 10 ] TSH must be routinely monitored since there is a risk of coronary artery disease , hyperthyroidism and excessive bone loss from inadequate or abnormal thyroid replacement.
T 3 is the more metabolically active hormone produced from T 4.T 4 is deiodinated by three deiodinase enzymes to produce the more-active triiodothyronine: . Type I present in liver, kidney, thyroid, and (to a lesser extent) pituitary; it accounts for 80% of the deiodination of T 4.
By the 1970s doctors could measure T4, T3, and TSH in human blood with approximate accuracy and confirmed that treatment with thyroxine alone could produce normal blood levels of both T4 and T3, [26] but desiccated thyroid caused supraphysiologic levels of T3. [27]
Both T 3 and T 4 are used to treat thyroid hormone deficiency (hypothyroidism). They are both absorbed well by the stomach, so can be given orally. Levothyroxine is the chemical name of the manufactured version of T 4, which is metabolised more slowly than T 3 and hence usually only needs once-daily administration.
Low-T3 syndrome and high-T3 syndrome: Consequences of step-up hypodeiodination, e.g. in critical illness as an example for type 1 allostasis, [20] or hyperdeiodination, as in type 2 allostasis, including posttraumatic stress disorder. [12] Resistance to thyroid hormone: Feedback loop interrupted on the level of pituitary thyroid hormone receptors.
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Affected patients may have normal, low, or slightly elevated TSH depending on the spectrum and phase of illness. Total T4 and T3 levels may be altered by binding protein abnormalities, and medications. Reverse T3 levels are generally increased, while FT3 is decreased. FT4 levels may have a transient increase, before becoming subnormal during ...
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