Free TFT (Free T3, Free T4, TSH)

Thyroid

Report in 4Hrs

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No Fasting Required

Details

Quantifies thyroid-stimulating hormone; crucial in diagnosing hypothyroidism or hyperthyroidism.

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Free TFT (Free T3, Free T4, TSH) - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Purpose: Measures the levels of free thyroid hormones (Free T3 and Free T4) and thyroid-stimulating hormone (TSH) in the bloodstream to assess thyroid function and diagnose thyroid disorders
- Primary Indications: Suspected hyperthyroidism or hypothyroidism, monitoring thyroid medication effectiveness, evaluating symptoms such as fatigue, weight changes, temperature sensitivity, mood disturbances, or palpitations
- Common Reasons for Testing: Diagnosis of Graves' disease, Hashimoto's thyroiditis, thyroid nodules, postpartum thyroiditis, medication management (thyroxine replacement), periodic screening in high-risk populations, fertility evaluation, and monitoring during pregnancy
- Timing of Test: Performed during initial evaluation of thyroid symptoms, at baseline before starting thyroid treatment, 6-8 weeks after medication changes to allow steady-state levels, periodically during ongoing treatment, and in patients with endocrine disorders or taking medications affecting thyroid function
Section 2: Normal Range
- TSH (Thyroid Stimulating Hormone): 0.4 - 4.0 mIU/L (or milliunits per liter). Normal range indicates proper pituitary-thyroid axis feedback regulation
- Free T4 (Thyroxine): 0.8 - 1.8 ng/dL (or 10 - 23 pmol/L). Represents unbound T4 available for tissue use
- Free T3 (Triiodothyronine): 2.3 - 4.2 pg/mL (or 3.5 - 6.5 pmol/L). The more metabolically active form of thyroid hormone
- Interpretation Guidelines: • Normal values indicate euthyroid (normal thyroid) state with appropriate metabolic function • High TSH with low Free T4 suggests primary hypothyroidism • Low TSH with high Free T4 and/or Free T3 suggests hyperthyroidism • Reference ranges may vary between laboratories and assay methods used
Section 3: Interpretation
- Elevated TSH with Low Free T4: Indicates primary hypothyroidism where thyroid gland fails to produce adequate hormones, prompting pituitary to increase TSH production. Clinical features include fatigue, weight gain, cold intolerance, constipation, dry skin, and slowed metabolism
- Low TSH with High Free T4 and/or Free T3: Indicates hyperthyroidism with excessive thyroid hormone production. Pituitary suppresses TSH in response. Symptoms include palpitations, anxiety, tremor, weight loss, heat intolerance, and hyperactivity
- Low TSH with Normal or Low Free T4/T3: May indicate secondary hypothyroidism (pituitary disorder), tertiary hypothyroidism (hypothalamic disorder), or early-stage thyroid disease
- Elevated TSH with Normal Free T4: Suggests subclinical hypothyroidism with mild thyroid insufficiency. Free T4 remains in range due to compensatory TSH elevation, but patient may be at risk for progression
- Low TSH with Normal Free T4/T3: Suggests subclinical hyperthyroidism or over-replacement with thyroid medication. Hormone levels currently adequate but TSH suppression may lead to complications
- Factors Affecting Results: • Medications: Beta-blockers, amiodarone, corticosteroids, lithium, iodine-containing drugs • Pregnancy and postpartum period cause physiological changes in thyroid function • Acute illness, stress, and severe malnutrition can suppress TSH • Age: TSH tends to increase gradually with advancing age • Circadian rhythm: TSH peaks early morning, nadir in evening
Section 4: Associated Organs
- Primary Organ System: Endocrine system, specifically the thyroid gland (butterfly-shaped gland at base of neck), hypothalamus, and anterior pituitary gland which comprise the hypothalamic-pituitary-thyroid (HPT) axis
- Common Associated Disorders: • Hashimoto's thyroiditis (autoimmune hypothyroidism) • Graves' disease (autoimmune hyperthyroidism) • Thyroid nodules and thyroid cancer • Iodine deficiency disorder • Thyroiditis (viral, bacterial, or silent) • Thyroid storm (severe hyperthyroidism) • Myxedema coma (severe hypothyroidism)
- Multi-System Effects of Thyroid Dysfunction: • Cardiovascular: Arrhythmias, hypertension, atherosclerosis, heart failure • Metabolic: Altered glucose metabolism, hyperlipidemia, obesity • Neuropsychiatric: Depression, anxiety, cognitive impairment, dementia risk • Reproductive: Infertility, irregular menses, miscarriage risk, fetal abnormalities • Skeletal: Osteoporosis, increased fracture risk
- Potential Complications from Untreated Thyroid Disease: Atrial fibrillation, heart failure, severe depression with suicide risk, infertility, preeclampsia in pregnancy, congenital hypothyroidism in offspring, thyroid storm with multi-organ failure, myxedema coma with respiratory depression
Section 5: Follow-up Tests
- Antibody Testing (if autoimmune disease suspected): • Anti-TPO (thyroid peroxidase) antibodies - indicate Hashimoto's disease • Anti-thyroglobulin antibodies - detect thyroid autoimmunity • TSI (thyroid-stimulating immunoglobulin) or TRAb - confirm Graves' disease
- Imaging Studies: • Thyroid ultrasound - evaluate nodules, parenchymal changes, echogenicity • Thyroid scintigraphy (radioiodine scan) - assess functional activity in hyperthyroidism • CT or MRI - evaluate retrosternal thyroid extension or mass effect
- Additional Laboratory Tests: • Total T3 and Total T4 - if protein binding alterations suspected • Thyroglobulin level - monitor thyroid cancer patients post-treatment • Lipid panel - evaluate dyslipidemia in hypothyroidism • Liver function tests - if amiodarone or propylthiouracil therapy planned
- Monitoring Schedule for Treated Patients: • Initial diagnosis: Retest 6-8 weeks after medication initiation • Dose adjustment: Retest 6-8 weeks after each change • Stable on therapy: Annually or as clinically indicated • Pregnancy: Every 4 weeks during first trimester, then every 6-8 weeks • Thyroid cancer: Per oncology protocol, typically every 3-6 months initially
- Specialty Consultations: Endocrinologist referral for complex cases, thyroid surgery consideration (goiter, cancer), hyperthyroidism management, or difficulty achieving euthyroid state
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is not required for Free TFT testing. Blood sample can be drawn at any time of day regardless of meal intake
- Optimal Timing for Accurate Results: Morning draw (between 7-10 AM) recommended because TSH exhibits circadian rhythm with peak levels in early morning. Consistent timing facilitates meaningful comparison of serial measurements
- Medication Instructions: • Levothyroxine: Take morning dose on day of test AFTER blood draw, or delay dose until afternoon to prevent false suppression of TSH • Other thyroid medications: Consistent timing with test is important; inform laboratory of medication schedule • Biotin supplements: Discontinue 3-5 days before test as biotin can falsely elevate Free T4 and suppress TSH in some assays • Iron supplements and calcium: Take at least 4 hours before or after thyroid medication as they interfere with absorption
- Pre-Test Patient Preparation: • No special dietary restrictions • Maintain normal hydration • Minimize physical and emotional stress before test, if possible • Avoid strenuous exercise immediately before blood draw • List all current medications and supplements for healthcare provider • Wait at least 30 minutes after iodine-containing contrast procedures before testing
- Special Considerations: Recent iodine exposure (contrast dye, amiodarone) can affect results for several weeks; recent heparin therapy may interfere with assays; pregnancy significantly alters thyroid hormone levels; recent illness or hospitalization may transiently suppress TSH

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