Free T Bioavailability Metrics represent the critical laboratory indices that quantify the fraction of circulating thyroxine ($text{T}_4$) and triiodothyronine ($text{T}_3$) hormones that are unbound by plasma proteins. This unbound fraction is the only component capable of diffusing into tissues to exert genomic and non-genomic effects on cellular metabolism and differentiation. Accurate assessment of these metrics is paramount because total hormone levels can be misleading due to variations in thyroid-binding globulin (TBG) capacity. We prioritize these values to truly gauge the functional thyroid status of the patient.
Origin
This concept originates from the physical chemistry governing hormone transport in the circulatory system, where the vast majority of thyroid hormones are reversibly bound to carrier proteins. The term bioavailability signifies the fraction available for biological action, differentiating it from the total measured hormone pool. This refinement in measurement reflects decades of understanding in thyroid endocrinology regarding receptor access.
Mechanism
The mechanism relies on the equilibrium between bound and free hormone. Thyroid hormones bind primarily to TBG, transthyretin, and albumin, with the free fraction being inversely proportional to the binding capacity of these proteins. Clinical evaluation involves measuring the free fraction directly or calculating it using equilibrium dialysis or immunoassay techniques. This metric directly correlates with the physiological signal driving target cell nuclear receptor binding and subsequent regulation of basal metabolic rate.
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