Thyroid stimulation test with serum thyroxine concentration as index of thyroid response

A thyrotropin (T.S.H.) test is suggested which relies on the change in the concentration of serum thyroxine as the index of thyroid response to T.S.H. stimulation. Ten such tests have been carried out in healthy volunteers and 39 in patients referred for routine thyroid stimulation tests. Among the advantages of such a test are that the patient does not receive ionizing radiation; it is independent of the presence of iodide-or mercury-containing compounds; and it minimizes the number of patient visits. In remote areas the patient need not attend the specialist centre, because the T.S.H. injection can be given and the serum samples taken locally, the samples then being sent to the appropriate laboratory for assay.     

Trial of thyroid autotransplantation in patients with Graves' disease whose remnant thyroid has unintentionally been made too small at subtotal thyroidectomy

Autotransplantation of thyroid tissue was carried out in 5 patients with Graves' disease in order to prevent postoperative hypothyroidism, because the amount of remnant thyroid tissue was estimated to be too small, i.e. from 3 to 5 g. Approximately 0.5 to 2 g of thyroid tissue was cut into small pieces and transplanted into the sternocleidomastoid muscles or the strap muscles. Although the postoperative serum TSH levels were normal or slightly elevated, the serum concentrations of triiodothyronine were within the normal range in these 5 patients at a follow-up study carried out 2 to 7 years after surgery. Thyroid scanning with I-123 or 99mTc-pertechnetate (Tc-99m) revealed radioisotope uptake at the sites of transplantation in 4 of the 5 patients. These findings verify that the implanted thyroid tissues were alive and functioning and that autotransplantation may be a way of preventing postoperative hypothyroidism in patients whose remnant thyroid tissue has unintentionally become too small.     

Relationship among thyrotropin (TSH), thyroid stimulating immunoglobulins, and results of triiodothyronine (T3) suppression test in patients with Graves' disease

To investigate the relationship between TSH and abnormal thyroid stimulator(s) in patients with hyperthyroid Graves' disease in whom normal thyroid hormone levels in the serum were maintained by antithyroid drug therapy and in patients with euthyroid Graves' disease, determinations were made of the TSH concentration, action of thyroid stimulating immunoglobulins (TSAb and TBII), and T3 suppression. Out of thirty-three patients with hyperthyroid Graves' disease, twelve patients with subnormal TSH levels were all non-suppressible according to the T3 suppression test results and the detectability of TSAb and/or TBII was as high as 75%. In three out of five patients with euthyroid Graves' disease, the serum TSH level was subnormal. All three showed non-suppressibility in the T3 suppression test and positive action of either TSAb or TBII. One of them became clinically thyrotoxic when the TSAb activity was further increased and TBII became positive, and was therefore diagnosed as having hyperthyroid Graves' disease. The present findings suggest that there are still abnormal thyroid stimulator(s) in patients with hyperthyroid Graves' disease who have low TSH, even if their thyroid hormone concentrations remain normal. Moreover, it is likely that some of the patients with euthyroid Graves' disease are actually in a state of subclinical hyperthyroidism because of the presence of abnormal thyroid stimulator(s).     

Blocking activity to action of thyroid stimulating hormone in serum from patients with primary hypothyroidism.

Spontaneous primary hypothyroidism in adults is usually associated with autoimmune thyroiditis. The hypothesis that hypothyroidism may result from the presence in serum of a factor that blocks stimulation of the thyroid by thyroid stimulating hormone was examined. Serum samples were collected from 28 patients with recently diagnosed primary hypothyroidism. After removal of endogenous thyroid stimulating hormone the effect of the serum on secretion of triiodothyronine induced by thyroid stimulating hormone or thyroid stimulating antibodies was examined in thyroid slices incubated in vitro. Serum samples from six of the patients demonstrated significant blocking of the stimulation by bovine thyroid stimulating hormone. Inhibition of the stimulatory action of thyroid stimulating antibodies was also exhibited by serum samples with blocking activity. It is concluded that in some patients with primary hypothyroidism a serum factor, which is probably an IgG, exists that can block the thyroid response to thyroid stimulating hormone and thyroid stimulating antibodies; it may represent an important mechanism in the pathogenesis of hypothyroidism.     

Goitres in rats fed polychlorinated biphenyls.

Rats fed a polychlorinated biphenyl (PCB) mixture in a high- or low-iodine diet (HID or LID respectively) for 15 days had thyroid enlargement, low serum thyroxine (T4), and high serum thyrotropin concentrations. Although binding of thyroid hormones to serum proteins was reduced in PCB-fed animals, the free T4 index (reflecting free T4 in serum) was less in these rats. Both serum triiodothyronine (T3) and the free T3 index were elevated in rats fed PCB in HID. LID-maintained rats elevated serum T3 concentrations but the free T3 index was similar to that in HID-fed rats, owing to enhanced binding of thyroid hormone to serum proteins. Addition of PCB to LID reduced serum T3 levels but did not alter the free T3 index because binding was less. In rats fed HID containing PCB, thyroid 131I uptake was increased.     

左甲状腺素钠片联合甲状腺片用于甲状腺癌术后TSH抑制治疗的临床效果评价

摘要 目的：探究左甲状腺素钠片联合甲状腺片用于甲状腺癌术后促甲状腺激素（TSH）抑制治疗的临床效果。方法：选择2021年1月-2022年6月本院收治的甲状腺癌手术并进行碘131清甲治疗后行TSH抑制治疗的80例患者为本次研究对象,开展动态分组法,对照组及观察组,n=40。单纯左甲状腺素钠片治疗为对照组,左甲状腺素钠片联合甲状腺片治疗为观察组。比较甲状腺功能、肝肾功能、治疗效果及不良反应。结果：治疗后,游离三碘甲状腺原氨酸（FT3）、游离四碘甲状腺原氨酸（FT4）水平,观察组及对照组均较治疗前提高,但观察组低于对照组;TSH水平,两组均较治疗前降低,且观察组较对照组低（P＜0.05）;治疗前,肌酐（Scr）、谷丙转氨酶（ALT）、谷草转氨酶（AST）水平,观察组及对照组比较无差异（P＞0.05）,治疗后,各指标水平,两组均较治疗前降低,且观察组较对照组低（P＜0.05）;观察组治疗有效率高于对照组（P＜0.05）;观察组及对照组不良反应率比较无差异（P＞0.05）。结论：左甲状腺素钠片联合甲状腺片用于甲状腺癌术后TSH抑制治疗可明显改善患者甲状腺功能,提高免疫功能及治疗效果,效果优于左甲状腺素钠片单独治疗,且安全性较高。     

Highly sensitive immunoradiometric assay for TSH and thyroid radioiodine uptake as predictors of thyroid suppression test

Suppression of TSH and thyroid radioiodine uptake by doses of either T4 or T3 were compared in 33 patients in whom Graves' thyrotoxicosis had been treated with thioamide drugs and the medication was discontinued for at least 4 months. Thyroidal radiodine uptake was suppressed in 19 patients and was not suppressed in the remaining 14 patients. Basal TSH levels before suppression were 2.07 microU/ml in the former, significantly exceeding those of the latter (0.91 microU/ml). A TSH level of at least 1.2 microU/ml before suppression is a good predictor of positive thyroid radioiodine suppression with a predictive value of 76%. A level lower than 0.7 microU/ml before suppression is a good predictor of negative thyroid radioiodine uptake suppression with a predictive value of 89%. The determination of TSH levels before the thyroid suppression test was helpful in predicting the result, but there were limitations. In the thyroid suppression test positive group, circulating T4 was depressed by doses of T3. In them, the magnitude of T4 depression correlated with the levels of thyroid radioiodine uptake before suppression. The levels of TSH correlated neither to changes in T4 nor to those in thyroid radioiodine uptake. This indicates that the thyroid glands which show high radioiodine uptake are sensitive to TSH and are also sensitive to suppression. The elevated sensitivity to TSH probably warrants the disappearance of abnormal thyroid stimulation more precisely.     

Ophthalmic Graves's disease: natural history and detailed thyroid function studies.

Of 27 patients with ophthalmic Graves''s disease (OGD) who had been clinically euthyroid three years previously, one became clinically hyperthyroid and seven overtly hypothyroid. Improvement in eye signs was associated with a return to normal of thyroidal suppression by triiodothyronine (T3) and of the response of thyroid-stimulating hormone (TSH) to thyrotrophin-releasing hormone (TRH). Of a further 30 patients with OGD who had not been studied previously, three were overtly hypothyroid. Of the combined series, 46 patients were euthyroid, 18 (40%) of whom had an impaired or absent TSH response to TRH, and 3(6-7%) an exaggerated response. Eleven out of 37 patients (29-7%) had abnormal results in the T3 suppression test. There was a significant correlation between thyroidal suppression by T3 and the TSH response to TRH. Total serum concentrations of both T3 and thyroxine (T4) were closely correlated with T3 suppressibility and TRH responsiveness. Free T4 and T3 (fT3) concentrations were normal in all but three patients, in whom raised fT3 was accompanied by abnormal TSH responses and thyroidal suppression. The presence of normal free thyroid hormone concentrations in patients with impaired or absent TSH responses to TRH is interesting and challenges the concept that free thyroid hormones are the major controlling factors in the feedback control of TSH.     

Profil des hormones thyroïdiennes chez les femmes enceintes : analyse de 125 cas à l’hôpital général de Yaoundé

This study was aimed at determining the evolution and the kinetics of thyroid hormones in a sub-population of pregnant women in Cameroon. We carried out a prospective study (from January 2005 to January 2006) on 125 consenting pregnant women at the Yaoundé General Hospital. Clinical and gyneco obstetric data with the gestational age were noted on a pre-designed questionnaire. Blood samples were drawn for serum assay of thyroxin (T4), triiodothyronine (T3) and thyroid stimulating hormone. The results were read with the “Oakfield health care” Gamma – 12 counter using the RIASTAT software. These patients, divided into four groups consisted of: 32 non pregnant women in the control group; 33 pregnant women in the first trimester; 30 pregnant women in the second trimester and 30 at the third trimester. The mean serum levels of T3 and T4 were relatively high in all pregnant women (irrespective of the gestational age) than in the control group. Serum levels of T3 and T4 were raised the first trimester with and progressively reduced in 2nd and 3rd trimester. On otherhand, TSH levels progressively increased as from the 2nd trimester to attain a maximum in the 3rd trimester. We can therefore conclude that blood levels of thyroid hormone as well as TSH vary during pregnancy and differ in titres with respect to the gestation age.     

Optimum replacement dose of thyroid hormone assessed by highly sensitive TSH determination in patients with congenital hypothyroidism

Serum thyroid hormone concentrations were measured in 100 samples from 25 patients with congenital hypothyroidism who were clinically well while receiving L-T4 therapy. Thyroxine concentrations were significantly higher than those of controls (p less than 0.01), while triiodothyronine was not significantly different. These samples were divided into four groups according to serum thyroid stimulating hormone concentrations as measured by highly sensitive immunoradiometric assay (IRMA-TSH). Serum thyroid hormone concentrations were compared among groups. The replacement dose of L-T4 and serum thyroid hormone in groups with undetectable IRMA-TSH were significantly higher than those in groups with normal or increased IRMA-TSH. These results show that serum thyroxine concentrations increase in most patients with congenital hypothyroidism on L-T4 therapy. Therefore, thyroxine concentrations above normal are not necessarily of clinical significance if IRMA-TSH is detectable. Undetectable IRMA-TSH might indicate the necessity for a reduction in the L-T4 replacement dose in patients with congenital hypothyroidism.     

Assessment of thyroid function: towards an integrated laboratory--clinical approach

Laboratory assessment of thyroid function is now often initiated with a low pre-test probability, by clinicians who may not have a detailed knowledge of current methodology or testing strategies. Skilled laboratory staff can significantly enhance the choice of appropriate tests and the accuracy of clinical response; such involvement requires both appropriate training and relevant information from the clinician. Measurement of the serum thyroid stimulating hormone (TSH) concentration with an assay of adequate sensitivity is now the cornerstone of thyroid function testing; for untreated populations at risk of primary thyroid dysfunction, a normal TSH concentration rules out an abnormality with a high degree of certainty. However, in several important situations, most notably pituitary abnormalities and early treatment of thyroid dysfunction, serum TSH can give a misleading indication of thyroid status. An abnormal TSH concentration alone is never an adequate basis for initiation of treatment, which should be based on the typical relationship between trophic and target gland hormones, based on serum TSH and an estimate of serum free thyroxine (T4). Six basic assumptions, some clinical, some laboratory-based, need to be considered, together with the relevant limiting conditions, for reliable use of this relationship. Current methods of free T4 estimation remain imperfect, especially during critical illness. Diagnostic approach differs significantly between initial diagnosis and follow-up of treated thyroid dysfunction. In some situations, serum triiodothyronine (T3) is also required, but serum T3 lacks sensitivity for diagnosis of hypothyroidism, and has poor specificity during non-thyroidal illness. Where assay results are anomalous, most atypical findings can be resolved by attention to the clinical context, without further investigation.     

甲状腺癌术后短期甲状腺功能低下对骨代谢的影响

目的:观察分化型甲状腺癌(DTC)患者手术后、碘131(131I)清甲治疗前停用甲状腺素造成的短期甲减对骨代谢的影响。方法:选择DTC术后患者53例作为试验组,50例健康人作为对照组,试验组于停服甲状腺素第二天空腹采血行游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、血钙(Ca)、血磷(P)、血清碱性磷酸酶(ALP)、血清骨钙素(BGP),I型前胶原羧基末端前肽(PICP)、I型胶原交联羧基末端肽(ICTP)等各项检查,停服甲状腺素4周后于131I治疗前再行上述检查,对照组于体检当日采空腹血测相同项目。结果:试验组患者停药前血清FT3、FT4水平明显高于对照组,差异有统计学意义(P0.05)。停服甲状腺素后,试验组患者血清TSH升高,T3、T4水平降低,血BGP、血Ca、PICP、ICTP水平降低,与停药前及对照组的检验结果相比均有明显差异(P0.05)。停药后,骨密度与停药前比较差异无统计学意义(P0.05)。停服甲状腺素前后血磷水平无明显变化,与对照组相比也没有明显差异(P0.05)。结论:甲状腺癌术后造成甲状腺功能低下可明显影响患者骨代谢,应于131I后及时给予甲状腺激素,及时纠正甲低状态,同时也可适量补充钙剂。     

Effects of therapeutic and toxic doses of levamisole on thyroid hormones and some biochemical parameters in sheep

This study was carried out to establish the effects of therapeutic and toxic doses of levamisole on thyroid hormone levels and some biochemical parameters in sheep. Twelve Akkaraman ewes were used. Levamisole was given orally at doses of 7.5 mg kg(-1) (group 1) and 40 mg kg(-1) (group 2) to the animals. Blood samples were taken from the jugular vein at 2, 4, 8, 24, 48, 96 and 144 h after the administrations. Serum thyroid hormones and some biochemical parameters were determined on these samples. When compared with the control levels, no significant changes were observed in triiodothyronine (T3) and thyroxin (T4) levels in group 1. Although levamisole was found to increase the levels of total T3, it decreased the levels of total T4 in group 2. On the other hand, free T3 and free T4 levels were not changed in either group. While serum alkaline phosphatase (ALP) activities were decreased, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatinine kinase (CK) activities were increased significantly by levamisole. However, it increased the serum albumin and cholesterol levels, but decreased the inorganic phosphate levels in groups 1 and 2. On the other hand, when compared with the control levels, no significant changes were detected in serum sodium, potassium and calcium levels. In conclusion, therapeutic and toxic doses of levamisole were determined to affect thyroid metabolism and some biochemical parameters in sheep.     

Similar serum concentrations of thyroid hormones in two geographically separate populations on disparate iodine intake.

Serum thyroid hormones were measured in Montreal, Canada (urinary iodine 446 +/- 164 micrograms/day) and Zagreb, Yugoslavia (urinary iodine 108 +/- 32 microgram/day). The serum concentrations of thyroxine and triiodothyronine in the two populations were almost identical. We conclude that dietary iodine, within accepted normal limits, is not a factor in determining serum thyroid hormone levels. The wide differences in reported serum triiodothyronine concentrations are related to methodological problems.     

A role for thyroid hormones in the development of premigratory disposition in redheaded bunting,Emberiza bruniceps

Excessive fat deposition and zugunruhe (nocturnal restlessness), two characteristics of premigratory disposition, are displayed in caged redheaded buntings. In earlier experiments thyroid ablation was found to inhibit premigratory fattening in this bird. Also, seasonal investigations on thyroid hormonal profiles indicated a distinct rise in circulating tri-iodothyronine just before spring migration, most likely as a result of increased peripheral monodeiodination of thyroxine. The physiological relevance of these findings has been assessed in the present paper. Results indicated that removal of thyroid gland completely prevented development of zugunruhe and fat deposition; replacement therapy with T4 or T3 restored both. Thyroxine-induced fattening in thyroidectomized birds was found to be dose responsive. In two experiments in thyroidectomized and intact birds each suppression of extrathyroidal conversion of thyroxine into triiodothyronine by iopanoic acid completely suppressed zugunruhe and fattening in thyroidectomized as well as intact birds, arguing for a role of triiodothyronine in migratory physiology. Blockage of thyroxine to triiodothyronine conversion, however, did not suppress feather regeneration, indicating that unlike effects on migratory parameters in the same individuals thyroxine-induced feather regeneration does not involve prior monodeiodination to triiodothyronine. Thus, contrary to the prevailing view that triiodothyronine alone is the finally active thyroid hormone (thyroxine being a precursor), both thyroxine and triiodothyronine may have specific roles to play in the physiology of seasonal events, and peripheral conversion of thyroxine to triiodothyronine may be one of the physiological devices to ensure that energetically incompatible events like migration and moulting do not occur simultaneously. Results also indicate that increasing spring daylengths which are known to trigger avian migration may influence peripheral conversion of thyroxine to triiodothyronine possibly imparting to this physiological process an adaptive value in the timing of seasonal events.Abbreviations IOP iopanoic acid - NS normal saline - RIA radioimmunoassay - T4 thyroxine - T3 triiodothyronine - Tx thyroidectomized     

Effects of medium composition and metabolic inhibitors on glycosaminoglycan synthesis in chick embryo cartilage and its stimulation by serum and triiodothyronine.

Incorporation of inorganic sulfate into glycosaminoglycans of chick embryo sternum is stimulated by serum and triiodothyronine. Variations in the amino acid content of the medium, and in particular in the concentration of glutamine, changed the incorportion in control and stimulated sterna to the same degree. Omission of Na+ from the medium greatly reduced incorporation in both control and stimulated sterna; incorporation, and its stimulation by triiodothyronine, was restored by raising the concentration of Na+. Ouabain and valinomycin inhibited incorporation more than 90%, and triiodothyronine did not stimulate under these conditions. Puromycin and cycloheximide also inhibited incorporation almost completely, and abolished the stimulation by triiodothyronine and serum. Addition of p-nitrophenyl-beta-xyloside, in the presence of of puromycin ir cycloheximide, restored sulfation to a level of 5-10% of the control value; however, this level of incorporation was not increased by addition of serum or triiodothyronine. Actinomycin D, colchicine and vinblastine inhibited incorporation by 40% or less at the highest concentrations tested; however, these three agents completely abolished the ability of triiodothyronine to stimulate incorporation. Lumicolchicine and cytochalasin B decreased incorporation in controls slightly but did not affect the stimulation by serum or triiodothyronine. The results indicate that thyroid hormones stimulate glycosaminoglycan synthesis only under conditions which support efficient synthesis in control incubations, and suggest that microtubule formation may be essential to the mode of action of thyroid hormones in this system.     

Normalization of thyroid stimulating hormone levels in acromegalic patients after selective adenomectomy

Changes in TSH secretion in six acromegalic patients were studied before and after transsphenoidal adenomectomy (Hardy's method) and compared to normal subjects and six patients with prolactinoma. Basal serum GH levels ranging from 5 to over 250 ng/ml before adenomectomy decreased to below 5 ng/ml after the operation, and the abnormal responses of GH to TRH observed initially in three of the six patients almost disappeared in the post-adenomectomy period. The response of serum TSH to TRH in acromegalic patients improved in each of the six patients after the operation. The TRH-stimulated TSH secretion in patients with prolactinoma of a size and grade similar to those in acromegalic patients was not so extremely low as that in the acromegalic subjects. As indicators of thyroid function, serum triiodothyronine (T3), thyroxine (T4), T3-uptake levels and free T4 indices did not change significantly after adenomectomy as compared with those before the operation in five of the six patients tested. Serum T3, T4 and T3-uptake levels and free T4 indices before adenomectomy were normal or subnormal in each patient except for a high serum T4 level and free T4 index before the operation in only one patient. Thus, it is difficult to conclude that the function of thyrotrophs was decreased by pressure upon the intact pituitary gland by the tumor, or that the thyroid gland also became hypertrophic secondary to the elevated GH, resulting in a large quantity of thyroid hormone being secreted, which caused a suppression of TSH secretion by negative feedback.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of selenium on thyroid hormone metabolism in filial cerebrum of mice with excessive iodine exposure

The effects of supplementing selenium on thyroid hormone metabolism were studied on mice with excessive iodine exposure. The serum concentrations of thyroxine (T₄) and triiodothyronine (T₃) and the activities of iodothyronine 5′ and 5-deiodinase (D2, D3) were measured in the brain of filial mice to study the influence of selenium on thyroid hormone metabolism. Measurements were carried out on postnatal day 0, 14, and 28. It was found that selenium supplementation alleviated the adverse effects of excessive iodine on progeny. The serum TT₄ level as well as TT₄ and TT₃ concentrations and D3 activity in cerebrum of progeny decreased, whereas D2 activity increased in the cerebrum of progeny on postnatal day 0 and 14. Selenium supplementation exerted some favorable effects on thyroid hormone metabolism in cerebrum of progeny of dam with excessive iodine intake.     

A sensitive immunoradiometric assay for serum thyroid stimulating hormone: a replacement for the thyrotrophin releasing hormone test?

The value as a thyroid function test of a new, rapid, and highly sensitive immunoradiometric assay for thyroid stimulating hormone (TSH) was assessed in 188 consecutive new patients with suspected hyperthyroidism. The diagnosis was made on clinical grounds and on the basis of serum total triiodothyronine and thyroxine concentrations and the response of TSH to thyrotrophin releasing hormone (TRH) as measured by radioimmunoassay. In all except one patient the basal TSH concentration by immunoradiometric assay predicted the response of TSH by radioimmunoassay to TRH, an undetectable value being recorded in patients with a subnormal response and a measurable value in those with a normal test result. This clear relation was not observed for basal TSH concentrations as measured by radioimmunoassay. In a series of 39 hospital inpatients with acute or chronic non-thyroidal illness, of whom 11 had low concentrations of total thyroxine or triiodothyronine, or both, basal TSH concentrations were detectable by both radioimmunoassay and immunoradiometric assay in all cases and were associated with normal responses to TRH. The immunoradiometric assay for TSH, which is commercially available, may therefore obviate the need for the more time consuming TRH test and simplify the approach to thyroid function testing in patients with suspected hyperthyroidism.     

Interaction of thyroid hormones and cortisol on binding proteins of cytosol and nuclear extract of human leukocytes

Competitive properties of thyroid hormone analogues and cortisol for the binding of triiodothyronine and thyroxine, expressed as apparent inhibition constants (Ki), have been measured in nuclear extract and cytosol proteins of human leukocytes by means of electrophoresis in polyacrylamide gradient gel and charcoal-dextran assay. In the cytosol not only thyroid hormones but also cortisol competed for the binding of triiodothyronine and thyroxine as tested by charcoal-dextran assay. By means of electrophoresis two protein fractions binding thyroid hormones were found: protein fraction designed A (m. w. 100,000) and protein fraction B (m. w. 83,000). In protein fraction A the inhibition constant Ki for thyroid hormones are lower than in protein fraction B. In the protein fraction B not only thyroid hormones but also cortisol competed for the binding of triiodothyronine and thyroxine. In the nuclear extract the thyroid hormones were bound in one protein fraction C (m. w. 58,000) only. In this protein fraction only thyroid hormones, but not cortisol, are competitors for the binding of triiodothyronine and thyroxine and in the following descending order: triiodothyronine, thyroxine, tetraiodothyroacetic acid, thyroxamine and D-thyroxine. The competition of cortisol for the binding of thyroid hormones in cytosol protein fraction B in connection with some serum TBG changes in patients after prednisone administration is discussed.