A clinically euthyroid man with a family history of hyperthyroidism presented for evaluation of an elevated thyroxine (T4) level and an increased free T4 index with a normal thyrotropin (TSH) level. Results of thyroid hormone-binding protein tests confirmed the diagnosis of familial dysalbuminemic hyperthyroxinemia. This disorder should be considered in patients who have a normal serum TSH level, despite an elevated total T4 concentration. Accurate diagnosis is essential to avoid inappropriate treatment. Affected family members also should be identified. No treatment is required, because patients remain euthyroid and maintain a normal free T4 level.
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