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What Does High Free T4 Level After Stopping Carbimazole Indicate?

Posted on Mon, 6 Oct 2014

Question: Need help making sense of this. I was being treated for high free t4 for two and a half years. Free t4 was 27 at time of treatment starting. Two weeks ago I was told to stop carbimazole as free t4 was 20 tsh was 3.9. Had bloods taken after two weeks free of carbimazole and mow tsh is 1.8 but free t4 is 25. Doctor says this is good I don't need carbimazole and my matural free t4 is just on the high side. How can this be?

Answered by Dr. Binu Parameswaran Pillai (41 minutes later)

Brief Answer:
hello

Detailed Answer:
Good day
Noted your concern.
May I know your initial full Thyroid function tests?
I need the initial TSH and Free T3 reports please. Could you attach them?
There are number of situations where FreeT4 alone is high. Eg: Thyroid hormone resistance, Thyroid binding globulin deficiency etc.

Hence, it is important to know the initial TSH and FreeT3 value as well. Could you attach them?
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (12 minutes later)

XXXXXXX 2012 free t4 27 tsh 1.28 free t3 no record.

Answered by Dr. Binu Parameswaran Pillai (7 minutes later)

Brief Answer:
hio

Detailed Answer:
Hello
Since the TSH was normal, there is no need of neomercazole. If you have headache or blurring of vision, then it is worth doing a pituitary MRI to rule out the remote possibility of a TSH adenoma. But I must say it is very rare. If you have no symptoms now, please relax. Since you are off neomercazole, please repeat the blood works for thyroid 3 months later. But pleSe do Free T3, Total T4 and TBG along with the TSH and Free T4. That will help us to assess further.
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (7 minutes later)

The only symptoms I have or indeed ever had are palpation. I must add I have had extensive cardiac tests and my heart is fine. However during the last period and indeed during XXXXXXX 12 when first put on carbimazole I was under huge stress at work (local goverment). Would if be fair to presume that as the stress could have put a natural transient spike in free t4 reading. Many thanks.

Answered by Dr. Binu Parameswaran Pillai (5 minutes later)

Brief Answer:
hi

Detailed Answer:
Not really. Stress alone wouldn't change Free T4 .
I feel you have either Thyroid hormone resistance or TBG deficiency. Palpitation is indeed a symptom of Thyroid hormone resistance.

The best option would be to re do the tests in three months. But please include a TBG and Total T4 as well

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (4 minutes later)

That sounds scary. My own doctor and endo never mentioned such things. Is it treatable.

Answered by Dr. Binu Parameswaran Pillai (2 hours later)

Brief Answer:
possibilities

Detailed Answer:
Please don't worry. I just listed out the possibilities.
It need to be confirmed. If a repeat test shows a high Free T4 with normal TSH, we need to think about these possibilities. They are of course treatable.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar