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Clinical experience with sensitive thyrotropin measurements: diagnostic and therapeutic implications.
J Nucl Med. 1985 Nov; 26(11):1248-56.JN

Abstract

A two-site immunoradiometric assay for serum thyrotropin (TSH) was modified to improve the analytical sensitivity. The sensitivity achieved (detection limit, approximately 0.1 microU/ml; lower limit of quantitative measurement, approximately 0.4 microU/ml) was comparable to that of the best competitive binding research assays, yet this assay can be performed routinely. Serum TSH was 1.82 +/- 0.69 (mean +/- s.d.) (range 0.4-3.4 microU/ml) in healthy individuals and 1.83 +/- 0.90 microU/ml (range 0.7-3.7 microU/ml) in patients with nonthyroidal disorders. By contrast, 97% of clinically hyperthyroid patients (Graves' disease, toxic nodular goiter) with high serum free T4 (FT4) and T3 had suppressed serum TSH values, i.e., less than 0.3 microU/ml. Among patients with euthyroid Graves' ophthalmopathy or nontoxic goiter those clinically suspected of mild hyperthyroidism had TSH values less than 0.3 microU/ml, while those judged euthyroid had normal values. A large proportion of thyroid patients on antithyroid drugs (poorly to well-controlled) had suppressed TSH. Of Graves' patients in remission (normal FT4 and T3), 75% had normal TSH, but individual levels changed significantly over time, suggesting that a progressive decline in TSH may be useful in predicting recurrences. In hypothyroid patients taking L-T4, serum TSH was subnormal in patients with elevated FT4, but TSH was also low in six patients clinically suspected to be thyrotoxic despite normal FT4 and T3 and in 32% of asymptomatic patients with normal thyroid hormone levels. Conversely, 23% of thyroid cancer patients who had undergone thyroidectomy were taking insufficient L-T4 to completely suppress TSH secretion. In 25 individuals who underwent thyrotropin releasing hormone (TRH) stimulation tests, the baseline serum TSH value correlated well with the peak serum TSH value post-TRH (r = 0.85). We conclude that sensitive TSH measurements could establish or confirm the diagnosis of hyperthyroidism in equivocal cases, replace most TRH-stimulation tests and be of value in optimizing L-T4 suppression therapy for thyroid cancer patients post-thyroidectomy.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

3840528

Citation

Bayer, M F., et al. "Clinical Experience With Sensitive Thyrotropin Measurements: Diagnostic and Therapeutic Implications." Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, vol. 26, no. 11, 1985, pp. 1248-56.
Bayer MF, Kriss JP, McDougall IR. Clinical experience with sensitive thyrotropin measurements: diagnostic and therapeutic implications. J Nucl Med. 1985;26(11):1248-56.
Bayer, M. F., Kriss, J. P., & McDougall, I. R. (1985). Clinical experience with sensitive thyrotropin measurements: diagnostic and therapeutic implications. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 26(11), 1248-56.
Bayer MF, Kriss JP, McDougall IR. Clinical Experience With Sensitive Thyrotropin Measurements: Diagnostic and Therapeutic Implications. J Nucl Med. 1985;26(11):1248-56. PubMed PMID: 3840528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical experience with sensitive thyrotropin measurements: diagnostic and therapeutic implications. AU - Bayer,M F, AU - Kriss,J P, AU - McDougall,I R, PY - 1985/11/1/pubmed PY - 1985/11/1/medline PY - 1985/11/1/entrez SP - 1248 EP - 56 JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine JO - J. Nucl. Med. VL - 26 IS - 11 N2 - A two-site immunoradiometric assay for serum thyrotropin (TSH) was modified to improve the analytical sensitivity. The sensitivity achieved (detection limit, approximately 0.1 microU/ml; lower limit of quantitative measurement, approximately 0.4 microU/ml) was comparable to that of the best competitive binding research assays, yet this assay can be performed routinely. Serum TSH was 1.82 +/- 0.69 (mean +/- s.d.) (range 0.4-3.4 microU/ml) in healthy individuals and 1.83 +/- 0.90 microU/ml (range 0.7-3.7 microU/ml) in patients with nonthyroidal disorders. By contrast, 97% of clinically hyperthyroid patients (Graves' disease, toxic nodular goiter) with high serum free T4 (FT4) and T3 had suppressed serum TSH values, i.e., less than 0.3 microU/ml. Among patients with euthyroid Graves' ophthalmopathy or nontoxic goiter those clinically suspected of mild hyperthyroidism had TSH values less than 0.3 microU/ml, while those judged euthyroid had normal values. A large proportion of thyroid patients on antithyroid drugs (poorly to well-controlled) had suppressed TSH. Of Graves' patients in remission (normal FT4 and T3), 75% had normal TSH, but individual levels changed significantly over time, suggesting that a progressive decline in TSH may be useful in predicting recurrences. In hypothyroid patients taking L-T4, serum TSH was subnormal in patients with elevated FT4, but TSH was also low in six patients clinically suspected to be thyrotoxic despite normal FT4 and T3 and in 32% of asymptomatic patients with normal thyroid hormone levels. Conversely, 23% of thyroid cancer patients who had undergone thyroidectomy were taking insufficient L-T4 to completely suppress TSH secretion. In 25 individuals who underwent thyrotropin releasing hormone (TRH) stimulation tests, the baseline serum TSH value correlated well with the peak serum TSH value post-TRH (r = 0.85). We conclude that sensitive TSH measurements could establish or confirm the diagnosis of hyperthyroidism in equivocal cases, replace most TRH-stimulation tests and be of value in optimizing L-T4 suppression therapy for thyroid cancer patients post-thyroidectomy. SN - 0161-5505 UR - https://www.unboundmedicine.com/medline/citation/3840528/Clinical_experience_with_sensitive_thyrotropin_measurements:_diagnostic_and_therapeutic_implications_ L2 - http://jnm.snmjournals.org/cgi/pmidlookup?view=long&pmid=3840528 DB - PRIME DP - Unbound Medicine ER -