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Free T3 is a second- or third-level test of thyroid function.
It provides further confirmation of hyperthyroidism,
supplementing the T4, sensitive thyrotropin (sTSH), and
total T3 assays.
Evaluating clinically euthyroid patients who have an
altered distribution of binding proteins
Monitoring thyroid hormone replacement therapy
Normally, triiodothyronine (T3) circulates tightly bound to
thyroxine-binding globulin and albumin. Only 0.3% of the total T3
is unbound (free), but the free fraction is the active form.
In hyperthyroidism, both thyroxine (tetraiodothyronine;T4) and T3
levels (total and free) are usually elevated, but in a small subset of
hyperthyroid patients (T3 toxicosis) only T3 is elevated. Generally,
free T3 measurement is not necessary since total T3 will suffice.
However, free T3 levels may be required to evaluate clinically
euthyroid patients who have an altered distribution of binding proteins
(e.g., pregnancy, dysalbuminemia).
Some investigators recommend the FT3 assay for monitoring thyroid
replacement therapy, although its clinical role is not precisely defined.
> or =1 year: 2.0-3.5 pg/mL
Elevated FT3 values are associated with thyrotoxicosis or excess
thyroid hormone replacement.
FT3 is not a sensitive test for hypothyroidism.
Some patients who have been exposed to animal antigens, either
in the environment or as part of treatment or imaging procedures,
may have circulating antianimal antibodies present. These anti-
bodies may interfere with the assay reagents to produce unreliable
results.
1. Hay ID, Klee GG: Thyroid dysfunction. Endocrinol Metab Clin
North Am 1998;17:473-509
2. Wilson JD, Foster DW, Kronenburg HM, Larsen PR: Williams
textbook of endocrinology. 9th edition. WB Saunders Company
1998