We see a steady stream of people with FT4 (Free T4) and, if done, FT3 (Free T3) results which appear questionable.
This paper emphasises that the common assays do indeed have problems.
The paper's suggestion of getting an assay performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) is fine and might be "the answer" in some ways. But how on earth do you get off the starting blocks?
We all know that TSH-only testing is the rule. FT4 is lucky. And FT3 only if especially privileged! What are the chances of your doctor, especially a GP, pushing to get an LC-MS/MS assay? I can imagine going into an appointment and saying that you don't think your results reflect your actuality so, please do an LC-MS/MS assay. Unfortunately, I can also imagine a GP's response. (Not to blame the GP as they are likely unaware of the issues and cannot order such an assay even if they believe it appropriate.)
DIAGNOSIS OF ENDOCRINE DISEASE: How reliable are free thyroid and total T3 hormone assays?
in European Journal of Endocrinology
Authors: Kerry J Welsh 1 and Steven J Soldin 1
Abstract
Hypothyroidism is a very common disorder worldwide, for which the usual treatment is monotherapy with levothyroxine (L-T4). However, a number of patients treated with L-T4 continue to report symptoms of hypothyroidism despite seemingly normal levels of thyroid-stimulating hormone (TSH), free-T3 (FT3) and free-T4 (FT4) measured by immunoassay. This review summarizes the limitations of the immunoassays commonly used to measure thyroid hormone levels and emphasizes the advantages of the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS). Immunoassays for free thyroid hormone are affected by alterations in serum binding proteins that occur in many physiological and disease states. Multiple studies show falsely normal values for T3, FT3 and FT4 by immunoassay that are below the reference interval when measured by (ultrafiltration) LC-MS/MS, a reference method. We suggest evaluation of thyroid hormone levels by ultrafiltration LC-MS/MS for patients who continue to experience hypothyroid symptoms on LT-4. This may help identify the approximately 20% subset of patients who would benefit from addition of T3 to their treatment regimen (combination therapy).
Freely available here but, as it is an XML link, might not work on all platforms:
eje.bioscientifica.com/view...
Also, the full paper is in PubMed Central: