Triiodothyronine and thyroid-stimulating hormone response to thyrotrophin-releasing hormone. A new test of thyroidal and pituitary reserve

T4, T3 and reverse-T3 determinations in connection with the TRH test in the evaluation of possible hyperthyroidism

One disadvantage of the TRH test is that an absent or blunted TSH response is seen not only in hyperthyroid patients but also in some normal subjects. The aim of the present study was to elucidate whether the discriminatory power between eu- and hyperthyroidism could be increased by determining the T3 and T4 levels before and after the TRH administration. The study population consists of 30 patients referred for evaluation of suspected hyperthyroidism. The results show that all but one of the patients (n=20) who had T3 levels within the normal reference limits increased these levels after TRH administration, whether their TSH response was normal or blunted. One patient's T3 levels decreased after TRH. All the patients (n=10) who had T3 levels within the hyperthyroid range showed a decrease after TRH. The decrease was significantly correlated (r=0.90) to the magnitude of the increase. No consistent T4 and no change in reverse-T3 response was obtained. The addition of T3, T4 or reverse-T3 determinations in connection with the TRH test does not seem to increase the discriminatory power of the test.

Role of signal transducer and activator of transcription 3 in regulation of hypothalamic trh gene expression by leptin

During starvation in rodents, the hypothalamic-pituitary-thyroid axis is down-regulated, resulting in low circulating thyroid hormone levels. This involves a reduction in hypothalamic TRH mRNA that is caused in part by a fall in serum leptin levels, which is sensed by neurons within the hypothalamus. The mechanism by which this regulation occurs is not fully understood. Here we show transfection data and in vivo evidence, suggesting that leptin can regulate trh gene expression via activation of intracellular signal transducer and activator of transcription 3 (STAT3) proteins in TRH neurons. In trh promoter assays using transfected cells, functional STAT3 proteins are required for maximal activation of the trh promoter by leptin. Consistent with this, the STAT3-binding site on the leptin receptor is also required for this regulation. Using double immunohistochemistry, we show that peripherally administered leptin rapidly stimulates STAT3 phosphorylation in approximately 40% of TRH neurons in the paraventricular nucleus of the hypothalamus (PVN) in rats. Detailed anatomical analyses reveal that the leptin-responsive TRH neurons are concentrated in the caudal region of the medial and periventricular parvocellular subnucleus of the PVN. Combined, our data show that only a subpopulation of TRH neurons in the PVN is leptin responsive and suggest that stimulation of hypothalamic trh gene expression by leptin involves activation of STAT3 and that this signaling pathway is important for regulation of the hypothalamic-pituitary-thyroid axis by leptin.

Serum hormones in response to estradiol and (or) progesterone in ovariectomized cows after thyroidectomy

To evaluate the effect of gonadal steroid treatment and thyroidectomy on concentrations of gonadotropins and thyroid-stimulating hormone in the bovine, nonlactating Holstein cows were either thyroidectomized and ovariectomized (THYOVEX; n = 6) or ovariectomized only (OVEX; n = 4), and subsequently treated with no gonadal steroids (control), estradiol-17 beta (E2), progesterone (P4), or P4+E2 in a 2 x 4 factorial experiment. Averaged across steroid treatments, baseline concentrations of luteinizing hormone (LH; P < .05) and follicle-stimulating hormone (FSH; P < .10) were higher in THYOVEX cows than in OVEX cows. Pulse frequencies and amplitudes of LH and FSH did not differ between THYOVEX and OVEX cows. Secretion of TSH was pulsatile and all concentrations and pulsatile characteristics of TSH were increased (P < .05) in THYOVEX compared to OVEX cows. Treatment with E2 and P4 decreased (P < .05) baseline concentrations and magnitude of LH pulses, whereas P4+E2 increased (P < .01) pulse frequency of LH and FSH. Amplitude of LH and FSH pulses were not affected by treatment with either steroid. Treatment with P4+E2 decreased (P < .05) baseline concentrations of TSH, whereas pulse frequency, and magnitude and amplitude of TSH pulses were not altered by treatment with steroids. Mean concentrations of LH and FSH were similar during 48 hr after termination of E2 and P4+E2 treatments, but concentrations of TSH were higher (P = .06) after P4+E2 than after E2. Secretion of TSH showed a diurnal variation, with the lowest concentrations in the morning and highest in the afternoon. These results indicate that thyroidectomy influenced secretion of gonadotropins in OVEX cows.

Paracoccidioidomycosis in the region of Botucatu (state of São Paulo, Brazil). Evaluation of serum thyroxine (T4) and triiodothyronine (T3) levels and of the response to thyrotropin releasing hormone (TRH)

T4, T3 and TSH serum levels were measured in 25 patients with paracoccidioidomycosis. Thyroid T3 reserves were measured on the basis of the increase in T3 (delta T3) 2 h after intravenous injection of 200 micrograms TRH, and pituitary TSH reserves were measured on the basis of TSH increase (delta TSH) 20 min after the same injection. Twenty healthy volunteers with no history of thyroid disease were used as controls. When the two groups were compared, the following results were obtained: (a) there was no significant difference in mean T4, T3, delta TSH between groups; (b) reduced T3 levels were detected more frequently in patients with paracoccidioidomycosis, especially among those with the acute form of the disease or with the severely disseminated chronic form. The results suggest the occurrence of a reduction in peripheral conversion of T4 to T3, but do not indicate the occurrence of hypothyroidism in any of its forms (thyroid, pituitary or hypothalamic).

Effects of thyrotropin releasing hormone on human sudomotor and cutaneous vasomotor activities

At an ambient temperature of 34-41 degrees C (rh = 40%) forearm sweat rates were measured by capacitance hygrometry in 9 male volunteers. Thyrotropin releasing hormone (TRH) was infused intravenously at 0.1 mg.min-1 for 20 to 30 min. Sweat rate increased rapidly within a minute after initiation of TRH infusion, decreased rapidly after the peak sweat rate was attained in 2-5 min of TRH infusion, and then levelled off in 6-10 min near the level before TRH infusion. Core temperature (Tre, Tty) started to decline at the time of the peak sweat rate and levelled off almost coincidentally with the levelling off in sweat rate. Average values for the rate of sweat expulsions (Fsw), sweat rate and mean body temperature (Tb) were obtained from the data of the last 10 min period of TRH infusion. The regression line for the relationship of Fsw to Tb shifted during the TRH infusion to the left of the line for the control; that of sweat rate to Fsw hardly shifted. At an ambient temperature of 24-27 degrees C TRH produced vasodilation as evidenced by an increase in skin blood flow (measured by means of thermal distribution), an increase in amplitude of the photoelectric plethysmogram and an elevation of skin temperature in the finger tips. It is suggested that TRH may act, either directly or indirectly, on the central thermoregulatory mechanism (or on the thermoreceptive mechanism) to lower the reference temperature for heat dissipation.

Serum T3 and T4 determinations during the TRH test as a complement to improved discriminatory power in suspect hyperthyroidism

The aim of the study was to determine whether the addition of T3 and T4 determination in connection with a routine TRH-test could increase the discriminatory power of the test. Thus, forty-one patients with suspect hyperthyroidism were examined and samples for T3 and T4 and TSH determinations were drawn prior to the administration of TRH and at 20 and 60 min thereafter. The results showed that the addition of these thyroid hormone estimations did not increase the clinical value of the TRH-test.

Pituitary microadenoma: diagnostic studies

Forty-one women with oligo-menorrhoea and/or galactorrhoea were subjected to hypothalamic pituitary-thyroid testing in an attempt to establish the presence or absence of an underlying pituitary microadenoma. They were divided into two groups in accordance with the serum level of prolactin (PRL): Group I (N = 25, mean +/- SE 17.6 +/- 1.5 ng/ml) and Group II (N = 16, 102.8 +/- 29.7 ng/ml). The dynamic tests performed were a TRH test, a stimulation test with metoclopramide (MCP) and a suppression test with bromocriptine. The results of these tests were compared with those obtained in nine normal women and eleven patients with surgically proved pituitary microadenoma. Radiologically abnormal pituitary fossas were found in ten subjects from Group I and in fourteen from Group II. All patients were euthyroid. A persistently elevated serum TSH in response to TRH was observed in patients of Group II suggesting an hypothalamic abnormality and a progressive decrease in the 120-min use of serum T3 was noted with increasing evidence of the existence of a pituitary tumour. A negative correlation was found between the basal serum PRL and the rise of serum PRL with TRH. Patients from Group II showed a lower PRL response to MCP when compared to Group I and again a negative correlation between basal level of serum PRL and the change after MCP was observed. No clear difference in the 4-h response to bromocriptine was found between the different groups of subjects. In conclusion, none of the three tests analysed permitted us to establish which of the patients had an underlying pituitary microadenoma.

Response to thyrotrophin-releasing hormone and triiodothyronine suppressibility in euthyroid multinodular goitre

In twenty-two female patients with euthyroid multinodular goitre of varying size, thyroid suppression of 131I thyroid uptake by triiodothyronine (T3) and thyrotrophin (TSH) release after thyrotrophin-releasing hormone (TRH) administration were compared with thyroid weight, estimated by a planimetric method, and with serum thyroxine (T4) and T3 concentrations. Maximal increment of TSH (deltaTSH) after TRH and per cent T3-suppressibility were inversely related to thyroid weight and not related to basal serum T4 or T3 concentrations. deltaTSH and per cent suppression correlated positively, but deltaTSH was more often subnormal than T3-suppressibility. A practical consequence of our study is that nonconformity of the two tests may occur. This should be kept in mind in the evaluation of patients with thyroid disorders.

Function of hypothalamo-pituitary thyroid axis in depressed patients

Nineteen out of 51 depressed patients showed abnormal TSH response to TRH in terms of exaggerated, diminished and delayed responses. The basal value of T3 and its response to TRH were significantly lower in patients with delayed or diminished response than in the normal subjects. These results indicate that the dysfunction of the hypothalamo-pituitary thyroid axis plays an important role in the pathogenesis of depression.

An improved mathematical model of human thyroid hormone regulation

1. A mathematical model has been constructed of human thyroid hormone regulation by the anterior pituitary gland, which takes account of most of the currently available experimental data. 2. Successful simulation of data on the stimulation of thyrotrophin (TSH) secretion by thyrotrophin releasing hormone (TRH) was achieved assuming that the TSH secretion rate is proportional to the logarithm of the concurrent blood TRH level. 3. Data on the regulation of triiodothyronine (T3) secretion by TSH and the inhibition of TSH secretion by thyroid hormones in contrast could not be simulated on the assumption of instantaneous proportional responses. A mixture of proportional and integral control--the latter taking account of the past history of plasma levels of the regulatory hormone--appeared to be operating at both levels. 4. The pituitary gland appears to be more sensitive to a given fractional change in TRH secretion rate than to the same fractional change in T3 plasma concentration.

Effect of aging on thyroid economy in man

The effects of aging on the thyroid are discussed under the headings of metabolic indices, thyroid function, hormone production, blood concentration, and thyroregulatory mechanisms. Possibly elderly men differ from elderly women with regard to thyroid economy, but the available data are too few and contradictory to permit drawing firm inferences about the effects of aging.

The response of thyrotropin and triiodothyronine to various doses of thyrotropin releasing hormone in normal man

The relationship between serum thyrotropin (TSH) and serum triiodothyronine (T3) before and after injection of different doses of thyrotropin releasing hormone (TRH), given as single injections or as multiple injections with short intervals, was investigated in normal men. A positive correlation between prestimulated serum TSH and serum T3 levels and between the increase in the serum TSH and the serum T3 levels after TRH was found when repeated tests were performed in the same individual. There was a dose dependent TSH and T3 response to TRH. The smallest dose that produced a maximal response of both TSH and T3 was only 30 mug TRH. After six injections of 30 mug TRH with an interval of 30 minutes the increase in TSH was two times and the increase in T3 was three times as high as the maximal increase after single injections of TRH. This test with multiple injections of TRH may prove to be of clinical value in the measurement of both pituitary and thyroid function in selected patients. The close positive correlation between the serum TSH and serum T3 levels in basal conditions, demonstrated in four normal subjects in this study, probably reflects the steady state level determined by the hypothalamus from which the feedback control of TSH secretion operates.

Radioimmunoassay and the hormones of thyroid function

Radioimmunoassay (RIA) has provided the tools for wide-reaching investigations that have changed and continue to change many important concepts of thyroid physiology and pathosphysiology. The RIA vor human thyrotropin (TSH) was developed in 1965; development of the RIA for triiodothyronine (T3), thyroxine (T4), thyroxine-binding globulin (TBG), and, recently, thyrothropin-releasing hormone (TRH) and thyroglobulin (Tg) followed. The capacity to measure nanogram and picogram concentrations with relative ease and speed has permitted the demonstration of dynamic relationships of the intrathyroidal and circulating thyroid hormones to each other and to the pituitary and hypothalamic regulating hormones. Evidence for the presence of cross-influences between TRH and other hypothalamic regulating hormones on the secretion of pituitary hormones has accumulated. The impact of the new information on clinical practice is now becoming evident. There is new appreciation of the value of assaying serum T3 and TSH concentrations in the clinical management of patients with disturbed function of the thyroid, pituitary, or hypothalamus. The necessary components for RIA performance can be purchansed separately or in kit form from commercial sources. With appropriate quality-control procedures, precise, sensitive, and reliable data can be generated. Awareness of the specific technical problems relating to the RIA of these hormones is absolutely necessary to assure reliable results. The availability of kits or their components permits the performance of these studies in the community hospital and in reliable commercial-service laboratories.

Pituitary-thyroid responsiveness to intramuscular thyrotropin-releasing hormone based on analyses of serum thyroxine, tri-iodothyronine and thyrotropin concentrations

To develop a test of pituitary-thyroid responsiveness to thyrotropin-releasing hormone that would obviate the need for measuring serum thyrotropin, we determined serum thyrotropin, thyroxine, and tri-iodothyronine concentrations before and at frequent intervals after the intramuscular administration of 2 mg of thyrotropin-releasing hormone in normal subjects and in patients with a variety of thyroid disorders. In specimens obtained four and five hours after administration of the hormone to normal subjects, serum thyroxine concentration increased 2.4 plus or minus 0.7 mug per 100 ml (mean plus or minus S.D.) over base-line values, the magnitude of increase being greater than 1.5 mug per 100 ml in 32 of 34 subjects. Serum thyroxine concentrations after administration of thyrotropin-releasing hormone did not increase in 11 hyperthyroid patients. Of 13 with hypothyroidism, increases in 12 were 0 to 0.7 mug per 100 ml; in one the increment was 1.2 mug per 100 ml. Measurement of the serum thyroxine response to intramuscular thyrotropin-releasing hormone will usually suffice to determine the integrity of the hypothalamic-pituitary-thyroid complex.

In vitro testing of thyroid function: a review

Triiodothyronine (T(3)) is the major thyroid hormone and thyroxine (T(4)) may be only a "prohormone". A normal serum T(3) concentration can compensate for a low serum T(4) to maintain euthyroidism and on the other hand hyperthyroidism can exist in spite of a normal T(4) if the T(3) concentration is increased ("T(3)-toxicosis"). A raised serum thyroid stimulating hormone (TSH) concentration is the present most sensitive indicator of thyroidal hypothyroidism and the level can be used to titrate replacement therapy to the individual's own requirements. TSH concentration is classically low in hypothyroidism secondary to pituitary or to hypothalamic disorder and synthetic thyrotrophin release hormone can then be used to identify which of these two sites is at fault. Thyroxine is the best form of thyroid replacement for hypothyroidism because it produces more consistently physiological concentrations of T(3). Full replacement is achieved with 0.1 - 0.2 mg of T(4)/day and doses above this, as formerly widely used, may cause over-replacement. New reliable kit tests are available which give in one quick procedure a measure of free-thyroxine even in the presence of abnormalities of protein-binding. These kit tests are suitable for the routine screening of the whole spectrum of thyroid dysfunction and when combined, in appropriate instances, with radioimmunoassay procedures for serum T(3) and TSH, provide a battery of tests which will help in the diagnosis of the great majority of causes of thyroid dysfunction.

Modulation of pituitary responsiveness to thyrotropin-releasing hormone by triiodothyronine

The relative roles of triiodothyronine (T(3)) and thyroxine (T(4)) in modulating pituitary responsiveness to thyrotropin-releasing hormone (TRH) have been assessed. (a) 10 hyperthyroid patients with elevated serum T(2) and T(4) levels showed no pituitary response to TRH. After 2 wk of propylthiouracil therapy T(4) levels had fallen to normal in only five patients while T(2) levels were normal in all. Pituitary responsiveness to TRH returned in all patients with normal or high T(4) concentrations. (b) Patients with isolated elevations of serum T(3) (T(3) toxicosis) failed to respond to TRH. TRH responsiveness was restored when T(3) levels fell to normal after propylthiouracil therapy. (c) When pituitary responsiveness to TRH was tested 60 min after a single oral dose of 50 mug of T(3), which increased serum T(3) levels to slightly above the normal range, no rise in thyrotropin (TSH) was seen in six subjects. These findings indicate that T(3) elevations alone can rapidly inhibit pituitary responsiveness to TRH.