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An important point here is that the two albumin peak heights are about equal, as is expected with bisalbuminemia.
There are genetic variants of albumin that are of significance that bind T4 with higher affinity (familial dysalbuminemic hyperthyroxinemia). In those genetic variants, total T4 is elevated but the patients are euthyroid. fT4 results in this situation are method dependent (see Cartwright D, et al. Familial dysalbuminemic hyperthyroxinemia; a persistent diagnostic challenge. Clin Chem 2009;55:1044–6.)
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