Anti-T4 and anti-T3 antibodies !!!

[Guest guest]

Came across this article in the Journal of Clinical Endocrinology and there is a

wonderful statement that I just have to share:

" Treatment is guided by normalization of the TSH and free T4 by equilibrium

dialysis. When the clinical picture and the laboratory assays appear

incongruous, other causes for abnormal thyroid hormone assays should be

explored. " So when our labs don't match our sympoms doctors - INVESTIGATE

FURTHER............

It mentions anti-T4 and anti-T3 antibodies, which I'd never heard of before.

The link to the article is:

http://edrv.endojournals.org/cgi/content/meeting_abstract/32/03_MeetingAbstracts\

/P1-669?sid=63b5e1a2-675f-4e60-ba35-07ea482fe980

The full (short) article is copied below.

Regards

Nadia

Endocr Rev, Vol. 32 (03_MeetingAbstracts): P1-669

Copyright © 2011 by The Endocrine Society

Thyroxine Autoantibody in a Patient with Hashimoto Thyroiditis and

Cryoglobulinemia

Masuda Alford, MD, Cheryl Potter and Mimi I Hu, MD

Department of Endocrine Neoplasia & Hormonal Disorders (EMA,CP,MIH), The

University of Texas MD Cancer Center, Houston, TX

IntroductionAutoimmune thyroid disorders are relatively common, with

approximately 1% of the general population affected and as many as 5-10% of

reproductive age women affected. Most commonly in iodine-sufficient regions,

anti-thyroperoxidase (TPO Ab) and anti-thyroglobulin antibodies (Tg Ab) account

for chronic autoimmune thyroiditis. Autoantibodies directed against either T4 or

T3 are rare causes of elevation of TSH. Here, we present a patient with

Hashimoto's thyroiditis and symptomatic hypothyroidism and elevated TSH but with

paradoxically elevated free T4.Case PresentationA 42 year old female with

history of marginal zone leukemia, hepatitis C, and cryoglobulinemia vasculitis

presented 4 years ago with more than 130 pound weight gain and fatigue. She was

evaluated by her primary care physician and diagnosed with hypothyroidism with

an elevated TSH. She was started on thyroid hormone replacement with improvement

of symptoms. She rapidly lost weight and was found to be over replaced, and her

dose was decreased. However, because of continued elevation of TSH, she was

referred for further evaluation. Repeat thyroid hormone levels showed TSH 17.28

mcu/ml (range 0.5-5.5) with free T4 >5 ng/dl (range 0.9-1.8) and total T3 78

ng/dl (range 80-190). She was clinically hypothyroid with cold intolerance,

fatigue, weight gain, and dry skin. Because of this unclear overall picture,

further analysis was performed. This showed patient had elevated TPO Ab 13,850

IU/ml (range <35) and Tg Ab 158,400 IU/ml (range <40), consistent with

Hashimoto's thyroiditis. However, as this did not explain her thyroid function

studies, further testing for presence of anti-T4 and anti-T3 antibodies was

performed. She was found to have anti-T4 antibody but no anti-T3 antibody. After

being placed on higher dose of levothyroxine, free T4 equilibrium dialysis was

1.4 ng/dl (range 0.8-2), while the standard free T4 was > 5 ng/dL and

concomitant TSH of 1.81 mcu/ml.ConclusionSeveral factors are known to interfere

with thyroid hormone assays, including medications and medical conditions such

as AIDS and Hepatitis C. To our knowledge, this is the first report of a patient

with cryoglobulinemia producing an anti-T4 antibody leading to an elevated free

T4 by standard testing. Treatment is guided by normalization of the TSH and free

T4 by equilibrium dialysis. When the clinical picture and the laboratory assays

appear incongruous, other causes for abnormal thyroid hormone assays should be

explored.

[Guest guest]

The trouble is Nadia, just like the Royal College of Physicians

and the British Thyroid Association once again, although they are recognising

that other non thyroidal illness might be the problem and telling doctors this

should be investigated further, they do not tell doctors how to do this and

which tests they should use. So doctors are being left in the dark - and worse,

patients symptoms continue to be ignored - and still they are told " you

are suffering with a functional somatoform disorder… " - meaning,

it's all in your head.

Came across this article in the Journal of

Clinical Endocrinology and there is a wonderful statement that I just have to

share:

" Treatment is guided by normalization of the TSH and free T4 by

equilibrium dialysis. When the clinical picture and the laboratory assays

appear incongruous, other causes for abnormal thyroid hormone assays should be

explored. " So when our labs don't match our sympoms doctors - INVESTIGATE

FURTHER............

It mentions anti-T4 and anti-T3 antibodies, which I'd never heard of before.

The link to the article is:

http://edrv.endojournals.org/cgi/content/meeting_abstract/32/03_MeetingAbstracts/P1-669?sid=63b5e1a2-675f-4e60-ba35-07ea482fe980