Interesting Cases

Details of the submitter

Name: KVS Hari Kumar
Institute: ESI

Case details

• 15 / F
• Presented 3 yr back with Goitre and weight gain
• Initial TFT (Low T3, Low T4 and TSH > 150)
• Treated by 2 physicians initially with LT4 up to 100 mcg (body weight 30-40 kg)
• TSH always above 50, hence referred to me
• Checked all the standard issues (Compliance, brand etc)
• T4 loading test is OK (FT4 increment values 0.59, 0.71, 0.91, 1.13, 1.19 and 1.11)
• Ig A TTG negative, menses regular, Albumin 4.6
• LT4 dose increased to 200 mcg (5 mcg/kg/day)
• TSH normalized but patient always has low TT3 and TT4 (TBG deficiency suspected)
• Complained of fatigue and doubtful hyperpigmentation, BP normal, no postural drop
• Basal cortisol 3.3 mcg/dL and ACTH 16.5
• Electrolytes normal (138 / 4.5)
• Post ACTH cortisol 23 mcg/dL

Details of the submitter

Name: KVS Hari Kumar
Institute: ESI

Case details

• 15 / F
• Presented 3 yr back with Goitre and weight gain
• Initial TFT (Low T3, Low T4 and TSH > 150)
• Treated by 2 physicians initially with LT4 up to 100 mcg (body weight 30-40 kg)
• TSH always above 50, hence referred to me
• Checked all the standard issues (Compliance, brand etc)
• T4 loading test is OK (FT4 increment values 0.59, 0.71, 0.91, 1.13, 1.19 and 1.11)
• Ig A TTG negative, menses regular, Albumin 4.6
• LT4 dose increased to 200 mcg (5 mcg/kg/day)
• TSH normalized but patient always has low TT3 and TT4 (TBG deficiency suspected)
• Complained of fatigue and doubtful hyperpigmentation, BP normal, no postural drop
• Basal cortisol 3.3 mcg/dL and ACTH 16.5
• Electrolytes normal (138 / 4.5)
• Post ACTH cortisol 23 mcg/dL