eMedicine Specialties > Endocrinology > Thyroid

Euthyroid Hyperthyroxinemia: Differential Diagnoses & Workup

Author: Reetu Singh, MD, Fellow, Department of Internal Medicine, Beebe Medical Center
Coauthor(s): Serge A Jabbour, MD, Associate Professor, Department of Medicine, Division of Endocrinology, Thomas Jefferson University
Contributor Information and Disclosures

Updated: Jul 23, 2008

Differential Diagnoses

Hyperthyroidism

Workup

Laboratory Studies

  • In resolving the cause of an elevated T4 level, consider the following:
    • Obtain a detailed clinical evaluation (ie, history, associated medical conditions, drugs, family history) and pay particular attention to the absence or presence of signs that are suggestive of hyperthyroidism.
    • Measure TSH by a third-generation assay showing the lack of suppression, except in hyperemesis gravidarum and severe systemic illness.
    • Measure free T4, especially by equilibrium dialysis (criterion standard). Free T4 is normal except in certain instances, such as when drugs (eg, heparin, propranolol, amiodarone, contrast agents) are being used or when acute psychosis, systemic illness, or hyperemesis gravidarum is present.7,20

Imaging Studies

  • No imaging studies are required to diagnose this condition.

More on Euthyroid Hyperthyroxinemia

Overview: Euthyroid Hyperthyroxinemia
Differential Diagnoses & Workup: Euthyroid Hyperthyroxinemia
Treatment & Medication: Euthyroid Hyperthyroxinemia
Follow-up: Euthyroid Hyperthyroxinemia
References
Further Reading
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References

  1. Borst GC, Eil C, Burman KD. Euthyroid hyperthyroxinemia. Ann Intern Med. Mar 1983;98(3):366-78. [Medline].

  2. Tang KT, Yang HJ, Choo KB, et al. A point mutation in the albumin gene in a Chinese patient with familial dysalbuminemic hyperthyroxinemia. Eur J Endocrinol. Oct 1999;141(4):374-8. [Medline]. [Full Text].

  3. Wada N, Chiba H, Shimizu C, et al. A novel missense mutation in codon 218 of the albumin gene in a distinct phenotype of familial dysalbuminemic hyperthyroxinemia in a Japanese kindred. J Clin Endocrinol Metab. Oct 1997;82(10):3246-50. [Medline]. [Full Text].

  4. Millichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. Feb 2008;121(2):e358-65. [Medline].

  5. Molashenko NV, Sviridenko NIu, Platonova NM, et al. [The specific features of thyrotoxicosis and euthyroid hyperthyroxinemia developed due to the use of cordarone]. Klin Med (Mosk). 2004;82(12):35-9. [Medline].

  6. Sänger N, Stahlberg S, Manthey T, et al. Effects of an oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg dienogest on thyroid hormones and androgen parameters: conventional vs. extended-cycle use. Contraception. Jun 2008;77(6):420-5. [Medline].

  7. Mooradian A, Morley JE, Simon G, et al. Propranolol-induced hyperthyroxinemia. Arch Intern Med. Nov 1983;143(11):2193-5. [Medline].

  8. Wiener M, Lo Y, Klein R. Abnormal thyroid function in older men with or at risk for HIV infection. HIV Med. Jun 11 2008;[Medline].

  9. Kvetny J, Poulsen H. Transient hyperthyroxinemia in newborns from women with autoimmune thyroid disease and raised levels of thyroid peroxidase antibodies. J Matern Fetal Neonatal Med. Dec 2006;19(12):817-22. [Medline].

  10. Moses AC, Rosen HN, Moller DE, et al. A point mutation in transthyretin increases affinity for thyroxine and produces euthyroid hyperthyroxinemia. J Clin Invest. Dec 1990;86(6):2025-33. [Medline]. [Full Text].

  11. Hishinuma A, Mochizuki Y, Kasai K, et al. [Thyroxine-binding proteins--familial euthyroid hyperthyroxinemia due to point mutations of transthyretin]. Nippon Rinsho. Apr 1994;52(4):886-9. [Medline].

  12. Magalhães PK, Rodrigues Dare GL, Rodrigues Dos Santos S, et al. Clinical features and genetic analysis of four Brazilian kindreds with resistance to thyroid hormone. Clin Endocrinol (Oxf). Nov 2007;67(5):748-53. [Medline].

  13. Tucker WS Jr. Euthyroid hyperthyroxinemia due to familial excess of thyroxine-binding globulin. South Med J. Mar 1989;82(3):368-71. [Medline].

  14. Maye P, Bisetti A, Burger A, et al. Hyperprealbuminemia, euthyroid hyperthyroxinemia, Zollinger-Ellison-like syndrome and hypercorticism in a pancreatic endocrine tumour. Acta Endocrinol (Copenh). Jan 1989;120(1):87-91. [Medline].

  15. Gharib H, Klee GG. Familial euthyroid hyperthyroxinemia secondary to pituitary and peripheral resistance to thyroid hormones. Mayo Clin Proc. Jan 1985;60(1):9-15. [Medline].

  16. Rushbrook JI, Becker E, Schussler GC, et al. Identification of a human serum albumin species associated with familial dysalbuminemic hyperthyroxinemia. J Clin Endocrinol Metab. Feb 1995;80(2):461-7. [Medline]. [Full Text].

  17. Eber O, Langsteger W, Florian W, et al. [Evaluating thyroid gland function in patients with protein anomalies]. Acta Med Austriaca. 1991;18(1):11-9. [Medline].

  18. George PM, Sheat JM, Palmer BN. Detection of protein binding abnormalities in euthyroid hyperthyroxinemia. Clin Chem. Sep 1988;34(9):1745-8. [Medline]. [Full Text].

  19. Jackson JA, Verdonk CA, Spiekerman AM. Euthyroid hyperthyroxinemia and inappropriate secretion of thyrotropin. Recognition and diagnosis. Arch Intern Med. Jul 1987;147(7):1311-3. [Medline].

  20. Stockigt JR, Barlow JW. The diagnostic challenge of euthyroid hyperthyroxinemia. Aust N Z J Med. Apr 1985;15(2):277-84. [Medline].

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Further Reading

Related eMedicine topics:
 Hypothyroidism [Endocrinology]
Hypothyroidism [Pediatrics: General Medicine]
Thyroid Disease
Thyroid Dysfunction Induced by Amiodarone Therapy

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Keywords

free thyroxine, free thyroxin, T4, thyroxine, thyroxin, triiodothyronine, T3, familial dysalbuminemic hyperthyroxinemia, FDH, hyperthyroidism, hypothyroidism, thyroid hormone resistance, thyroxine-binding prealbumin, thyroxin-binding prealbumin, TBPA, thyroxine-binding globulin, thyroxin-binding globulin, TBG, anti-T3 immunoglobulin, antitriiodothyronine immunoglobulin, anti-T4 immunoglobulin, antithyroxine immunoglobulin, acute psychosis, liver disease, glucagonoma, islet cell tumor, estrogen-secreting tumor, serum binding proteins, albumin

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Contributor Information and Disclosures

Author

Reetu Singh, MD, Fellow, Department of Internal Medicine, Beebe Medical Center
Reetu Singh, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Serge A Jabbour, MD, Associate Professor, Department of Medicine, Division of Endocrinology, Thomas Jefferson University
Serge A Jabbour, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, American Thyroid Association, Endocrine Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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