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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What do elevated free T4 and total T4 levels indicate?

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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2120 Questions

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Posted on Tue, 21 Aug 2018 in Thyroid Problem and Hormonal Problems
Question: Hello. My wife just received her blood test results, and it shows slightly elevated Free T4 at 4.5. Her total T4 is at 14.6. Are these elevations of concern for her at her age of 57!? She consistently has lower then usual blood pressure at around 80-90 over 60-70. Her HDL has fallen to 46, and LDL calculated is risen to 117 and non-HDL at 136. Thank you
doctor
Answered by Dr. Mirjeta Guni 2 hours later
Brief Answer:
Please attach the results;

Detailed Answer:
Hello and Welcome to ‘Ask A Doctor’ service.
I can understand your concern regarding your wife's health.
Would you please attach the reports so that I can have a better idea regarding the level of other hormones (if they have a tendency to be at the upper or lower ranges).
Is she taking any treatment now or did she ever took treatment for thyroid pathologies in the past?
Will be a pleasure to help you further.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Mirjeta Guni 4 hours later
Thank you, Dr. Mirjeta. Please see 3 attachments.
Oh, I think I see that all 3 pages have indeed been uploaded. About the thyroid, no activity has been undertaken in this regard yet. Thank you.
doctor
Answered by Dr. Mirjeta Guni 32 hours later
Brief Answer:
Please try to attach again!

Detailed Answer:
Hello,
Would you please try again as there does not appear any attachment!
Looking forward to help you further!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Mirjeta Guni 2 hours later
My page is showing that 3 files were uploaded: scan1.png, scan2.png and scan3.png. Please let me know if Ask A Doctor needs me to upload some other way than on the question page. Thank you.
doctor
Answered by Dr. Mirjeta Guni 26 minutes later
Brief Answer:
Attach reports:

Detailed Answer:
Hello,
There should be an icon ''upload reports''.
You have to attach them there.
Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Mirjeta Guni 38 minutes later
I did a screen shot and uploaded it showing the Healthcaremagic page indicating the three pages were uploaded. I can try uploading them again now........
Thank you very much. We don't understand why the doctor did not express concern about the thyroid issue. In any case, my wife should return to the doctor to discuss it again to check TSI but also to recheck the TSH, Ft3 and Ft4 in a month? We believe her numbers have been a little above the range for some years. Could it have had any effect on my wife all this time?
And concerning the cholesterol and blood pressure issues, is it a concern at this point? Thank you.
doctor
Answered by Dr. Mirjeta Guni 3 hours later
Brief Answer:
Check TSI antibodies:

Detailed Answer:
Hello,
Finally the results are uploaded.
I can see that TSH is within the normal ranges but total T4 and Free T4 index is high that means that the thyroid gland has a tendency to be overactive.
The ultrasound show 2 infracentimetric nodules that are not to get concerned about.
I would recommend do check stimulating thyroid antibodies (TSI) and if they are high, i would recommend to start treatment.
Othewise, keep monitoring TSH, Ft4 and Ft3 after 1 month.
Wish her good health.
Kind regards,
Dr.Mirjeta

.....

Brief Answer:
About your wife's problems;

Detailed Answer:
Hi again,

Regarding the side effects of longstanding hyperthyroidism, it should be more severe and persistent for many years.

In this case, I cannot say that it may have caused complications as FT4 is slightly elevated.

Regarding blood pressure, if she is under treatment, the dose of antihypertensives should be lowered. if she is not under treatment and the low blood pressure is symptomatic (feeling tired, dizziness etc) see your physician for further exams.

I'd suggest calculating the cardiovascular risk online to get a rough idea(cardiovascular risk calculation) and to decide if treatment for high LDL is needed. Please discuss this with her doctor too.

Wish her good health.
Best wishes,
Dr.Mirjeta



Above answer was peer-reviewed by : Dr. Arnab Banerjee
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