Measurement of Thyrotropin in Clinical and Subclinical Hyperthyroidism Using a New Chemiluminescent Assay*
Abstract
A new commercially available chemiluminescent TSH assay demonstrates an 8- to 10-fold increase in sensitivity over a sensitive immunoradiometric assay, allowing increased ability to distinguish partial from more complete thyrotroph suppression. Sera were analyzed from 145 patients who had TSH concentrations below 0.08 mU/L in the immunoradiometric assay. Most patients with overt hyperthyroidism had undetectable TSH concentrations in the chemiluminescent assay. Three groups of patients were identified, in which a large subgroup had undetectable values in the immunoradiometric assay and detectable values in the chemiluminescent assay (12 of 17 patients under treatment for hyperthyroidism who had recently normalized their serum thyroid hormone levels, 33 of 68 patients taking L-T4, and 4 of 8 patients with endogenous subclinical hyperthyroidism). In addition, several patients with undetectable basal and detectable TRH-stimulated TSH values in the immunoradiometric assay had detectable basal TSH values in the chemiluminescent assay. The utility of first generation TSH immunometric assays was their ability to distinguish hyperthyroidism from euthyroidism. The clinical utility of increasingly sensitive TSH assays will be to distinguish degrees of thyrotroph suppression in subclinical hyperthyroidism.
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Higher doses of levothyroxine are more likely to be associated with iatrogenic hyperthyroidism.
“Higher doses of levothyroxine are more likely to be associated with iatrogenic hyperthyroidism,36 59”
From Levothyroxine dose and risk of fractures in older adults: nested case-control study (2011) · cites this paper as [36]
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“HE NEW chemiluminescence assay of serum TSH concentrations, designated the ultrasensitive assay or third generation assay, helps distinguish partial from more complete thyrotropic suppression (1‐ 4). For example, most patients with Graves’ disease have been reported to have serum TSH concentrations below the detection…”
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- Authors
- ROSS, D. S., ARDISSON, L. J., & MESKELL, M. J.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- ORCID
- ROSS, DOUGLAS S.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1989-09
- Volume
- 69
- Issue
- 3
- Pages
- 684-688
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2004324253
- Cited by
- 75
- References
- 0
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2015: 1 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 5.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-01415)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid-stimulating hormone, TSH measurement, chemiluminescence immunoassay, subclinical hyperthyroidism, overt hyperthyroidism, immunoradiometric assay, levothyroxine, thyrotropin-releasing hormone stimulation, assay sensitivity
- MeSH terms
- Goiter, Humans, Hyperthyroidism, Luminescent Measurements, Radioimmunoassay, Thyroid Diseases, Thyrotropin, Thyroxine
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