Familial dysalbuminaemic hyperthyroxinaemia, a thyroid trap

[...]he was commenced on block and replace therapy with 25 [mu]g thyroxine. [...]albumin becomes the main binding protein, especially as it is available in a large quantity compared to TBG, but binding of thyroxine to triiodothyronine is normal. 1, 3, 6, 10, 11 In 1994, Peterson et al showed that the increased binding is due to substitution of arginine to histidine at position 218 on the albumin protein. 12 The incidence of FDH is not known, mainly due to the fact that the condition is diagnosed by chance when thyroid function tests are ordered. 1 Patients who are anxious when examined in the clinic may show signs such as tachycardia and sweating.