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Low or normal TSH, low free T3 or T4 Low or normal TSHand low free T3 or T4 test resultsrepresent a typical pattern in unwell patients with non-thyroidal illness, the most common combination of resultsbeing a low free T3 with a TSH in the normal range(panel 4).ge of onset varies from the neonatalperiod to adulthood, and a smooth or multinodular goitrecan develop. 20,21 Closely similar somatic mutations areresponsible for 80% of toxic nodules. Low TSH, normal free T3 or T4 Low TSH and normal free T3 and T4 test results areusually seen with thyroxine ingestion (panel 3).
In some cases of abnormal TSH values, measurement of T4 or T3 are performed to determine the extent of the thyroid abnormality. An elevated T4 or T3, in association with a low or suppressed TSH, establishes hyperthyroidism. An elevated TSH in conjunction with a low T4, is encountered in hypothyroidism.he pituitary hormone TSH stimulates the thyroid gland to make and release the thyroid hormones (T4 and T3). When thyroid hormone levels decrease, the TSH rises and vice versa. Measurement of TSH using a sensitive assay is presently the recommended initial screening test when thyroid disease is suspected.