Euthyroid Hyperthyroxinemia Workup

  • Author: Reetu Singh, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Nov 28, 2011
 

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.[8, 22]
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Imaging Studies

  • No imaging studies are required to diagnose this condition.
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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.

Specialty Editor Board

Steven R Gambert, MD  Professor of Medicine, Johns Hopkins University School of Medicine; Director of Geriatric Medicine, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center

Steven R Gambert, MD 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Romesh Khardori, MD, PhD, FACP  Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, and Endocrine Society

Disclosure: Nothing to disclose.

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.

References

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  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. Yeap BB, Alfonso H, Chubb SA, Walsh JP, Hankey GJ, Almeida OP, et al. Higher free thyroxine levels are associated with frailty in older men. The Health In Men Study. Clin Endocrinol (Oxf). Nov 11 2011;[Medline].

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  7. 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].

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

  9. 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].

  10. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, Negro R, Vermiglio F, Poppe KG. Treatment and Screening of Hypothyroidism in Pregnancy: Results of a European Survey. Eur J Endocrinol. Oct 24 2011;[Medline].

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  12. 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].

  13. 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].

  14. 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].

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  16. 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].

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  18. 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].

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  20. 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].

  21. 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].

  22. 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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