What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?

Female is in her later 40s with surgical oophorectomy taking Sertraline 50 mg daily and prn Trazodone and Lamotrigine. Has some weight loss and fatigue. No goiter nor any signs of hyperthyroidism on exam. Labs: TSH 0.14; TT4 1.6; Free T4 0.4 (normal range 0.8-1.8); free T3 4.6 (2.3-4.2). Repeat labs 4 months later: TSH 0.41; free T4 0.6; TT3 402 (76-181); free T3 8.0. Prolactin 7.2; FSH 2.1; LH 1.7. What can cause these abnormal TFTs?

Answer from: at Academic Institution

This patient has a low to low normal TSH, with weight loss and fatigue so I would approach this as mild hyperthyroidism, or T3 thyrotoxicosis. Sertraline has been associated with abnormal TFTs, usually an elevated TSH and low T4, not with increased T3 levels. Assess the patient for any other ...

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What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?

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