Thank you for your insight! That explains the guidelines.

But I'd thought it would be clear that expanded thyroid markers go hand in hand with diagnostics by endocrinologists or nuclear medicine via imaging (ultrasound & scinti)

It was not my intention to suggest to permanently add FT4/FT3 to normal TSH blood tests - just that sometimes patients can present that either read up on their symptoms/self-diagnosed or that some rarely don't fit into guidelines.

In a shared-decision making environment and under these specific circumstances, why not make it Burger King medicine and either discuss possible false positives or just refer to specialised care (MFM/Endo/Nuclear)