Radioimmunoassay for measurement of triiodothyronine in human serum

Recent advances in liquid chromatography-tandem mass spectrometry for the detection of thyroid hormones and thyroglobulin in clinical samples: A review

Thyroid hormones (THs), including triiodothyronine (T3), thyroxine (T4), and their metabolites, are essential for regulating development, growth, and energy metabolism. Thyroglobulin (Tg) produced by thyroid follicular cells acts as an essential substrate for TH synthesis. The combination of THs with Tg is a widely used serological laboratory test for thyroid function assessment. Early detection and timely intervention are significant for preventing and managing thyroid disease. In recent years, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has emerged as a powerful tool for the precise detection of small molecular analytes and steroid hormones in clinical practice as a result of its high sensitivity and specificity. While LC-MS/MS has been increasingly used for detecting THs and Tg recently, its application in clinical practice is still in its early stages. Recent advances in the assessment of thyroid metabolism using LC-MS/MS in clinical samples published during 2004-2023 were reviewed, with a special focus on the use of this technique for quantifying molecules involved in thyroid diseases.

Hematology profile, digestive enzymes, thyroid hormones, productivity, and nitrogen balance of growing male rabbits supplemented with exogenous dietary lysozyme

In a simple randomized design trial, 420 growing male V-Line rabbits were randomly distributed into four groups to investigate the impact of exogenous dietary lysozyme on some physiological and nutritional parameters of male growing rabbits supplemented with exogenous dietary lysozyme. The witness group received a basal diet without exogenous dietary lysozyme (LYZ0), while the exogenous dietary lysozyme groups received 50, 100 and 150 mg/kg of basal diet (Groups; LYZ50, LYZ100 and LYZ150), respectively. The results showed significantly increased in blood cell count, hemoglobin concentration, total white blood cell, lipase, protease, amylase, total protein, triiodothyronine and thyroxine levels, while thyroid stimulating hormone levels significantly lessened in rabbits received LYZ. The LYZ- rabbit diets improved total digestible nutrient, digestible crude protein, and digestible energy values, with the LYZ100 group outperforming the others. LYZ-treated rabbits had significantly higher nitrogen intake, digestible nitrogen, and nitrogen balance than the witness group. The lysozyme in a rabbit's diet is taking on a new role as a digestive enzyme, enhancement thyroid hormones, as well as improvement hematology, daily protein efficiency ratio, daily performance index, hot carcass, total edible parts, nutritional value, and nitrogen balance, with decreasing the daily caloric conversion ratio and total non-edible parts.

Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status

Background: Despite being the most performed laboratory endocrine investigation, the optimum use of thyroid tests (thyrotropin [TSH] and thyroid hormone [TH] measurement) is open to question and the interpretation of the results from these tests can be ambiguous. The American Thyroid Association (ATA) with its expertise support the endeavor of the U.S. Centers for Disease Control (CDC) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) to improve and maintain standardization and harmonization of thyroid testing. ATA mandated an international interdisciplinary working group panel to survey the status of thyroid testing by reviewing the recent literature to revise or update the criteria as needed in mutual agreement and to inform clinical care. Summary: This review represents the conclusions on the clinical use of current routine TSH and TH (thyroxine [T4] and triiodothyronine [T3]) assays, taking into account geographic differences in disease prevalence and clinical and laboratory practice among writing members. The interaction between physiological, pathophysiological, and pharmacological factors and thyroid assays can affect their measurements and confound result interpretation. These factors need to be considered in the clinical context of the patient for appropriate test ordering and result interpretation. Despite significant advances in laboratory methods over the past 50 years, routine thyroid assays remain susceptible to idiosyncratic analytical interference that may produce spurious results. Improved standardization needs to be demonstrated through ongoing international efforts before results from different assays can be considered equivalent. Emerging technology (e.g., mass spectrometry) shows promise for improved analytical performance, but more evidence of its clinical utility and improved throughput is required before it can be considered for routine use. Close clinical-laboratory collaboration is encouraged to overcome and avoid the pitfalls in thyroid testing as well as resolve clinically discrepant results. The evidence base supporting the conclusions of this review is summarized in four detailed online technical supplements. Conclusions: Over the past five decades, testing for TSH, T4, and T3 has evolved from manual radioisotopic immunoassays to nonisotopic multiplexed immunometric assays using highly automated equipment. Despite these technical advances, physicians and laboratorians performing these analyses must understand limitations of these methods to properly order tests and interpret results.

Laboratory Thyroid Tests: A Historical Perspective

Background: This review presents a timeline showing how technical advances made over the last seven decades have impacted the development of laboratory thyroid tests. Summary: Thyroid tests have evolved from time-consuming manual procedures using isotopically labeled iodine as signals (¹³¹I and later ¹²⁵I) performed in nuclear medicine laboratories, to automated nonisotopic tests performed on multianalyte instruments in routine clinical chemistry laboratories. The development of isotopic radioimmunoassay techniques around 1960, followed by the advent of monoclonal antibody technology in the mid-1970s, led to the development of a nonisotopic immunometric assay methodology that forms the backbone of present-day thyroid testing. This review discusses the development of methods for measuring total thyroxine and triiodothyronine, direct and indirect free thyroid hormone measurements and estimates (free thyroxine and free triiodothyronine), thyrotropin (TSH), thyroid autoantibodies (thyroperoxidase, thyroglobulin [Tg] and TSH receptor autoantibodies), and Tg protein. Despite progressive improvements made in sensitivity and specificity, current thyroid tests remain limited by between-method differences in the numeric values they report, as well as nonspecific interferences with test reagents and interferences from analyte autoantibodies. Conclusions: Thyroid disease affects ∼10% of the U.S. population and is mostly managed on an outpatient basis, generating 60% of endocrine laboratory tests. In future, it is hoped that interferences will be eliminated, and the standardization/harmonization of tests will facilitate the establishment of universal test reference ranges.

Mass spectrometry in the diagnosis of thyroid disease and in the study of thyroid hormone metabolism

The importance of thyroid hormones in the regulation of development, growth, and energy metabolism is well known. Over the last decades, mass spectrometry has been extensively used to investigate thyroid hormone metabolism and to discover and characterize new molecules involved in thyroid hormones production, such as thyrotropin-releasing hormone. In the earlier period, the quantification methods, usually based on gas chromatography-mass spectrometry, were complicated and time consuming. They were mainly focused on basic research, and were not suitable for clinical diagnostics on a routine basis. The development of the modern mass spectrometers, mainly coupled to liquid chromatography, enabled simpler sample preparation procedures, and the accurate quantification of thyroid hormones, of their precursors, and of their metabolites in biological fluids, tissues, and cells became feasible. Nowadays, molecules of physiological and pathological interest can be assayed also for diagnostic purposes on a routine basis, and mass spectrometry is slowly entering the clinical laboratory. This review takes stock of the advancements in the field of thyroid metabolism that were carried out with mass spectrometry, with special focus on the use of this technique for the quantification of molecules involved in thyroid diseases.

Shining light on single-strand lesions caused by the chemotherapy drug bleomycin

Quantification of the DNA damage induced by chemotherapy in patient cells may aid in personalization of the dose used. However, assays to evaluate individual patient response to chemotherapy are not available today. Here, we present an assay that quantifies single-stranded lesions caused by the chemotherapeutic drug Bleomycin (BLM) in peripheral blood mononuclear cells (PBMCs) isolated from healthy individuals. We use base excision repair (BER) enzymes to process the DNA damage induced by BLM and then extend the processed sites with fluorescent nucleotides using a DNA polymerase. The fluorescent patches are quantified on single DNA molecules using fluorescence microscopy. Using the assay, we observe a significant variation in the in vitro induced BLM damage and its repair for different individuals. Treatment of the cells with the BER inhibitor CRT0044876 leads to a lower level of repair of BLM-induced damage, indicating the ability of the assay to detect a compromised DNA repair in patients. Overall, the data suggest that our assay could be used to sensitively detect the variation in BLM-induced DNA damage and repair in patients and can potentially be able to aid in personalizing patient doses.

Quantifying DNA damage induced by ionizing radiation and hyperthermia using single DNA molecule imaging

Ionizing radiation (IR) is a common mode of cancer therapy, where DNA damage is the major reason of cell death. Here, we use an assay based on fluorescence imaging of single damaged DNA molecules isolated from radiated lymphocytes, to quantify IR induced DNA damage. The assay uses a cocktail of DNA-repair enzymes that recognizes and excises DNA lesions and then a polymerase and a ligase incorporate fluorescent nucleotides at the damage sites, resulting in a fluorescent “spot” at each site. The individual fluorescent spots can then be counted along single stretched DNA molecules and the global level of DNA damage can be quantified. Our results demonstrate that inclusion of the human apurinic/apyrimidinic endonuclease 1 (APE1) in the enzyme cocktail increases the sensitivity of the assay for detection of IR induced damage significantly. This optimized assay also allowed detection of a cooperative increase in DNA damage when IR was combined with mild hyperthermia, which is sometimes used as an adjuvant in IR therapy. Finally, we discuss how the method may be used to identify patients that are sensitive to IR and other types of DNA damaging agents.

Highlights in thyroidology: a historical vignette

This review gives a historical overview about the development of today's understanding of benign thyroid diseases and the possibilities of their treatment.Little was known about the thyroid gland until the nineteenth century: the state of knowledge was (1) that something in food, especially in seaweed, avoided the development of goiters, (2) that goiters seemed to have something to do with cretinism, and (3) that the thyroid gland is an organ consisting of two lobes connected by an isthmus. Shortly after the detection of iodine in 1811, its impact on its ability to avoid the development and the growing of goiters has been realized. The existence of iodine within the thyroid and in human plasma was detected approximately a decade later. The clinical picture of hyperthyroidism including endocrine orbitopathy was described in detail in the middle of the nineteenth century, the etiology of the disease remaining, however, unclear until a century later. In early nineteenth century, surgical goiter exstirpation was the only available form of treatment. Vienna and Berne were the centers leading worldwide in their expertise. Subcutaneous injections of sheep thyroid extracts were developed for treatment of postoperative hypothyroidism as well as congenital myxedema. Another approach suggested by Swiss surgeons was thyroid transplantation. Radioiodine therapy of hyperthyroidism was introduced in the middle of the twentieth century. Thyrostatic drugs are available since about the same time. The different forms of thyroiditis were described at the turn of the twentieth century. The etiology of chronic autoimmune thyroiditis was, however, clarified only some 50 years later independently by two groups of scientists, one in London, UK, and the other in Buffalo, USA. Thyroxine was isolated from bovine thyroid extracts in the beginning of the twentieth century. Its synthesis and correct chemical structure were described some 10 years later. The existence of 3,5,3'-triiodothyronine (T3), the biologically most active thyroid hormone, was detected in the 1950s of the past century by a group in Paris and another in London. The extrathyroidal conversion of thyroxine to T3, as the main source of circulating T3, was suggested shortly thereafter and substantiated in 1970. Finally, the development of the radioimmunoassay method for determination of hormone serum concentrations in 1959 enabled today's exact laboratory diagnosis of thyroid diseases.

Growth, metabolic status and ovarian function in buffalo (Bubalus bubalis) heifers fed a low energy or high energy diet

The aim was to establish the capacity of buffalo heifers to adapt their metabolic requirements to a low energy diet. Murrah buffalo (Bubalus bubalis) heifers undergoing regular estrous cycles were randomly assigned by age, live weight (LW) and body condition score (BCS) to a high energy group (HE, 5.8 milk forage units (MFU)/day, n=6) or low energy group (LE, 3.6 MFU/day, n=6). Circulating concentrations of metabolic substrates, metabolic hormones and reproductive hormones were determined weekly for 19 weeks. Ovarian follicular characteristics and oocyte parameters were also ascertained weekly. Heifers fed the LE diet had a better dry matter conversion than heifers fed the HE diet and the calculated daily energy provision was negative for heifers fed the LE diet (-0.248 MFU) and positive for heifers fed the HE diet (5.4 MFU). Heifers fed the HE diet had an increase in 50 kg LW over the duration of the study whereas LW remained constant for heifers fed the LE diet. The BCS of heifers fed the HE diet (4.2) was greater (P<0.05) than the BCS for heifers fed the LE diet (3.4). Heifers fed the HE diet had greater (P<0.05) circulating concentrations of metabolic substrates (glucose, total cholesterol and HDL cholesterol) and metabolic hormones (insulin, glucagon, leptin and T3) compared with heifers fed the LE diet. There were no significant differences in circulating reproductive hormones between the two groups of heifers. Ovarian follicular characteristics were similar for the two groups of heifers while heifers fed the LE diet tended to have oocytes of reduced quality compared with heifers fed the HE diet. The most notable finding was that heifers fed the LE diet had a negative calculated daily energy provision but were able to maintain LW and reproductive activity. It was concluded that buffalo heifers may potentially have the capacity to undergo metabolic adjustment and reduce their energy requirements when dietary energy is limiting. This adaptive capacity would explain why buffaloes remain productive in environments that are limiting to other ruminants.

A radioimmunoassay for measurement of 3,3'-diiodothyronine sulfate: Studies in thyroidal and nonthyroidal diseases, pregnancy, and fetal/neonatal life

Data suggesting that (1) sulfation of the phenolic hydroxyl of iodothyronines plays an important role in thyroid hormone metabolism and (2) maternal serum 3,3'-diiodothyronone sulfate (3,3'-T(2)S) may reflect on the status of fetal thyroid function stimulated us to develop a radioimmunoassay (RIA) for measurement of T(2)S. Our T(2)S RIA is highly sensitive, practical, and reproducible. T(4)S, T(3)S, and T(1)S crossreacted 3.1%, 0.81%, and 5.3%, respectively; thyroxine (T(4)), triiodothyronine (T(3)), and reverse (r)T(3), 3,3'-T(2) and 3'-T(1) crossreacted <0.1%. Although rT(3) sulfate (rT(3)S) crossreacted 55% in 3,3'-T(2)S RIA, its serum levels are very low and have little influence on serum T(2)S values reported here. T(2)S was measured in ethanol extracts of serum, amniotic fluid, and urine. Recovery of nonradioactive T(2)S added to serum was 96%. The dose-response curves of inhibition of binding of (125)I-T(2)S to anti-T(2)S by serial dilutions of ethanol extracts of serum or urine were essentially parallel to the standard curve. The detection threshold of the RIA varied between 0.17 and 0.50 nmol/L (or 10 and 30 ng/dL). The coefficient of variation (CV) averaged 9% within an assay and 13% between assays. The serum concentration of T(2)S was [mean +/- SE, nmol/L] 0.86 +/- 0.59 in 36 normal subjects, 2.2 +/- 0.06 in 10 hyperthyroid patients (P <.05), 0.73 +/- 0.10 in 11 hypothyroid patients (not significant [NS]), 6.0 +/- 1.5 in 16 patients with systemic nonthyroidal illness (P <.001), 18 +/- 2.5 in 16 newborn cord blood sera (P <.02), 2.7 +/- 0.32 in 25 pregnant women [15 to 40 weeks gestation, P <.001], 0.94 +/- 0.10 in 10 hypothyroid women receiving T(4) replacement therapy (NS), and 2.0 +/- 0.38 in 11 hypothyroid women treated with T(4) replacement and oral contraceptives (P <.02); serum T(2)S levels in the third trimester of pregnancy were similar to those in the second trimester of pregnancy. T(2)S concentration in amniotic fluid was 12.5 +/- 2.7 nmol/L (n = 7) at 15 to 20 weeks gestation, and it decreased markedly to 3.3 +/- 1.3 nmol/L (n = 3) at 35 to 38 weeks gestation. Urinary excretion of T(2)S in random urine samples of 19 normal subjects was 10.9 +/- 1.3 nmol/g creatinine. (1) T(2)S is a normal component of human serum, urine, and amniotic fluid, and serum T(2)S levels change substantially in several physiologic and pathologic conditions; (2) high serum T(2)S in pregnancy may signify increased transfer of T(2)S from fetal to maternal compartment, estrogen-induced increase in T(2)S production, decreased clearance, or a combination of these factors. The data do not support the notion that fetal thyroid function is the only or the predominant factor responsible for high serum T(2)S in pregnant women.

Long-term growth after hypophyseal stalk transection and hypophysectomy of beef calves

Hypothalamic hormones regulate episodic and basal secretion of hormones from the anterior pituitary gland that affect metabolism and growth in cattle. This study focused on long-term growth in young calves subjected to hypophysectomy (HYPOX), hypophyseal stalk transection (HST), and sham operation control (SOC). Cross-bred (Hereford x Aberdeen Angus) and Hereford, and Aberdeen Angus calves were HYPOX (n = 5), HST (n = 5), or SOC (n = 8) at 146 +/- 2 days of age, whereas another group was HST (n = 5) or SOC (n = 7) at 273 +/- 5 days of age. Body weight was determined every 21 days from birth to 1008 days of age. Anterior vena cava blood was withdrawn at 4-day intervals from day 64-360 for RIA of GH, TSH, T4, T3, and LH, and at 20-min intervals for 480 min to determine episodic hormone secretion. Daily feed intake was determined in HST and SOC calves during an 80-day period. Birth weight averaged 35 +/- 1 kg (+/- SE) and was 142 +/- 4 kg at 126 days and 208 +/- 8 kg at 252 days before surgery. From day 146-1008, growth was arrested (P < 0.001) in HYPOX (0.06 +/- 0.01 kg/day) compared with SOC (0.50 +/- 0.04 kg/day) calves. Growth continued but at a significantly lower rate (P < 0.05) in calves HST at 146 days (0.32 +/- 0.07 kg/day) and 273 days (0.32 +/- 0.06 kg/day) compared with SOC (0.50 +/- 0.09 kg/day). Growth continued to be impaired to 1008 days, but more so in those HST at 146 days (432 +/- 43 kg BW) than 273 days (472 +/- 5 kg BW) and less (P < 0.05) than SOC (586 +/- 37 kg BW). Daily feed intake was consistently less (P < 0.05) in HST compared with SOC calves. Although episodic GH secretion was abolished and peripheral serum GH concentration remained consistently lower in HST (2.4 ng/ml) than SOC (5.5 ng/ml; P < 0.01), the calves continued to grow throughout 1008 days. Peripheral serum TSH concentration was less (P < 0.05) HST compared with SOC calves. There was an abrupt decrease (P < 0.001) in serum T4 (4-fold) and T3 (3-fold) concentration after surgery that remained to 360 days in HST compared with SOC calves. At the time calves were killed, pituitary gland weight was markedly reduced (P < 0.001) in HST (0.18 +/- 0.01 g/100 kg BW) compared with SOC (0.54 +/- 0.03 g/100 kg BW). Histological examination of pituitary glands from HST calves indicated the persistence of secretory GH and TSH cells in the same areas of the adenohypophysis as SOC calves. Coronal sections of the gland stained with performic acid-Alcian blue-periodic acid-Schiff-orange G, revealed GH and TSH secreting cells in HST calves similar to controls. These results indicate that long-term growth continues, but at a slower rate, after hypophyseal stalk transection of immature calves in spite of complete abolition of episodic GH secretion and consistently decreased basal secretion of GH, TSH, T4, and T3 compared with sham-operated animals. Growth was abolished after hypophysectomy of immature calves in which circulating GH and TSH was undetectable.

Seasonal regulation of prolactin secretion in hypophyseal stalk transected beef calves

Seasonal regulation of prolactin secretion was investigated in crossbred beef heifer calves. Calves were randomly assigned to hypophyseal stalk transection (HST, n = 6) or sham-operation control (SOC, n = 6) groups and fitted 1 day before surgery with an indwelling external jugular catheter. Prolactin (PRL), growth hormone (GH), thyroid stimulating hormone (TSH), thyroxine (T4), and tri-iodothyronine (T3) in peripheral serum were measured by radioimmunoassay in samples obtained before and after HST or SOC. During the first 8 days after HST, PRL concentrations remained significantly greater than SOC, but then decreased in both HST and SOC calves to 4 +/- 2 (+/- SE) and 10 +/- 3 ng/ml, respectively (P < 0.001). PRL remained low in both HST and SOC groups for three months after surgery. By four months, HST calves had lower basal PRL (5 +/- 1 ng/ml) than observed in SOC (40 +/- 4 ng/ml), and seasonal changes in PRL blood concentration also were attenuated by HST. Although HST reduced PRL secretion, it did not abolish the effect of seasonal changes (P < 0.01); circulating PRL concentration increased six-fold by shifts in photoperiod and temperature from winter to summer in these stalk-transected calves. The SOC group had higher serum GH during the winter (3.8 +/- 0.8) than in July (1.3 +/- 0.03 ng/ml). The HST group had the opposite profile of GH concentration, however, with concentrations being higher during May through July. Thyroid stimulating hormone secretion was partly sustained after stalk transection possibly by negative feedback of reduced circulating thyroxine and tri-iodothyronine. These results in both hypophyseal stalk-transected and sham-operated beef calves maintained in a natural environment strongly suggest that hypothalamic regulation of PRL secretion by adenohypophyseal cells is extremely sensitive to seasonal changes throughout the year. Additionally, immediately after HST, PRL blood concentration remains significantly greater than in SOC calves but eventually decreases to low blood concentration in HST calves, and unlike that seen after HST in primates. Regardless, basal PRL serum concentration responds to seasonal changes, but a less distinct change in basal GH serum concentration in HST calves than seen in the SOC calves.

Sex-related differences in iodothyronine metabolism in the rat: evidence for differential regulation among various tissues

Various aspects of thyroid hormone metabolism were examined in vitro in age-matched (experiment I) and weight-matched (experiment II) male and female Sprague-Dawley rats; unless specified otherwise, results were similar in both experiments. The activity and content of iodothyronine 5'-monodeiodinase (type I-MD) in the liver of the female rat were markedly reduced, but there was no sex-related difference in these parameters in the kidney. The activity of the brain type III-MD was also not significantly influenced by the sex of the rat. Hepatic triiodothyronine (T3) sulfation activity in the females was only about 20% of that of the males. However, kidney and brain did not show this decrease in T3 sulfation. Similarly, hepatic T3 sulfate (T3S) desulfation activity was significantly reduced in the liver of the female rat (P < .001), whereas the activity in the kidney was either similar to (experiment I) or higher than (experiment II) that in the male, and the activity in the brain was similar in the two sexes. The mean serum T3S concentration in the female rat was no greater than 25% of the corresponding value measured in the male rat. The mean serum thyroxine (T4) concentration in female rats was similar to that in age-matched males (experiment I), whereas it was somewhat lower than that in weight-matched males (P < .05, experiment II). No significant difference in the mean serum T3 concentration was observed in rats of female and male sex. However, the mean serum thyrotropin (TSH) concentration in the female rat was significantly lower than that in the male.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of drugs on tests of thyroid function

Many drugs affect tests of thyroid function through alterations in the synthesis, transport and metabolism of thyroid hormones, as well as via influences on thyrotrophin (TSH) synthesis and secretion. Despite effects on circulating thyroid hormone and TSH levels, few drugs result in important changes in clinical thyroid state, but difficulty in interpretation of thyroid function tests often results. Commonly prescribed drugs including anti-convulsants, non-steroidal anti-inflammatory drugs, beta-adrenoceptor antagonists, steroid hormones and heparin may result in abnormal thyroid function tests in the absence of clinical features of thyroid dysfunction. In contrast, lithium and iodine containing drugs, including radiographic contrast agents and amiodarone, may result rarely in overt thyroid disease.

A longitudinal study on cortisol, prolactin and thyroid hormones in users of Norplant subdermal implants or a copper T device

A longitudinal study was undertaken to assess PRL, cortisol, TSH, T3 and T4 levels in NORPLANT implant users (n = 22) and Copper T users (n = 20). Participants were healthy women with no contraindication for hormonal contraception. Samples were drawn at 0930 to 1000 h twice pretreatment and at month 2, 4, 6, 12, 24 and 36 after insertion. At the second treatment month, a second sample was obtained at 1600 h to assess cortisol diurnal variation. Hormones were measured by RIA. Values for all hormones were similar in Norplant and Copper T users. No significant changes occurred throughout the study period. Elevated PRL levels (greater than 500 mU/1) were found in three women from each group before and during treatment but no clinical evidence of hyperprolactinemia was detected. The results of this study reassure that long-term use of NORPLANT implants do not impair plasma levels of cortisol, prolactin and thyroid hormones.

Rat hepatic and renal 5'-deiodination of rT3 during fasting: supportive role of intermediate Mr cytosolic non-glutathione thiol cofactor and NADPH

The roles of subcellular components and, in particular, cytosol fractions and beta-nicotinamide adenine dinucleotide phosphate, reduced form (NADPH), in the regulation of rat hepatic and renal 5'-deiodination during fasting were assessed. 5'-deiodinase (5'-DI) activities in reaction mixtures were measured by using outer ring 125I-radiolabelled reverse triiodothyronine (rT3) as a substrate in the presence of 200 mumol/L NADPH. Subcellular components from rats fed ad libitum or fasted for 24, 48 or 72 hours were prepared by standard differential centrifugation. Cytosol was chromatographed on a Sephadex G-50 column to obtain Fraction A of molecular weight (Mr) greater than 60,000 and Fraction B of Mr approximately 13,000 and to exclude reduced glutathione (GSH) (Mr less than 400). 5'-DI activity in liver homogenates was reduced by 42% at 24 hours and by 59% at 48 hours of fasting. In reconstitution experiments, liver microsomes showed a progressive loss of 5'-DI activity, reaching a maximal reduction of 46% at 72 hours of fasting. Activation of microsomal deiodinase by whole liver cytosol was also significantly reduced at 24 hours of fasting and achieved a maximal reduction of 5'-DI activation of 42% at 48 hours before substantial but incomplete recovery at 72 hours. Cytosolic Fraction A and B were assessed in combination with fed microsomes and NADPH. A close correlation was demonstrated between the loss of hepatic 5'-DI supportive activity in whole cytosol and that of Fraction B but not A during fasting.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of thyroid hormone on somatomedin-C release from perfused rat liver

The effect of thyroid hormone on plasma somatomedin-C (SmC) level and on SmC release from perfused rat liver was investigated. Plasma SmC levels and liver tissue SmC were significantly increased in thyroxine-treated rats. Physiological doses of triiodothyronine increased SmC release and SmC concentration in the perfused rat liver. These results indicate that thyroid hormone directly enhances the synthesis and release of SmC in the rat.

Recent advances in routine thyroid function testing

Thyroid function tests are one of the most common of endocrine laboratory investigations requested by general clinicians. The tests used therefore have to be efficient at identifying thyroid disease, monitoring treatment, and handling large numbers of tests. Recent advances in methodology have expanded both the range of in vitro thyroid function tests available and the techniques by which the well-established tests may be performed. This article reviews the methods and analytical and clinical performance of the routine tests currently available, concentrating particularly on the relatively new ones, and speculating on their role in strategies for the laboratory investigation of thyroid function.

Fever of unexplained origin, biochemical Cushing's disease and cerebral dysrhythmia corrected by valproate sodium

A patient with cerebral dysrhythmia and fever of unexplained origin for 2 years is described. She had elevated and nonsuppressible levels of urinary 17-hydroxycorticosteroids but no clinical features of hypercortisolism. Treatment with valproate sodium corrected all the abnormalities. It is postulated that cerebral dysrhythmia can affect the hypothalamic mechanisms of body temperature and regulation of adrenocorticotropic hormone levels.

Decreased insulin receptor binding in hyperthyroidism

The binding of 125I-insulin to insulin receptors on circulating mononuclear leukocytes was studied in ten patients with hyperthyroidism and 20 euthyroid normal volunteers. The hyperthyroid patients demonstrated significantly elevated glucose levels following an oral glucose load, despite normal insulin secretion. The infusion of insulin resulted in a delayed hypoglycaemic effect in the hyperthyroid patients; however, the inhibition of the endogenous insulin secretion as indicated by suppression of C-peptide levels was not different from euthyroid control subjects. Insulin binding to monocytes was significantly decreased in the hyperthyroid patients. Scatchard analysis of binding data indicates that a decrease of receptor number rather than receptor affinity seems to be the cause of the lowered insulin binding in hyperthyroid patients with diffuse toxic goitre. The findings of decreased insulin receptor number, mild degree of glucose intolerance despite normal insulin secretion and the delayed hypoglycaemic effect following insulin infusion suggest that peripheral insulin resistance could be involved in the highly complex pathophysiology of glucose intolerance in hyperthyroidism.

Recovery of serum TSH and thyroid hormones after 3'isopropyl-3,5-diiodo-L-thyronine (DIIP) treatment: absence of inhibiting effect of bromocriptine on TSH secretion and evidence for autoregulation of serum T3 levels

Bromocriptine, because of its dopaminergic activity, could possibly inhibit TSH secretion. This hypothesis was tested in 7 normal male volunteers. Thyroid function was suppressed with the very potent thyromimetic analogue, 3'isopropyl-3,5-diiodo-L-thyronine (DIIP). We wanted to observe, after stopping this treatment, whether the return of serum T3, T4, rT3 and TSH values was influenced by concomitant bromocriptine treatment (5 mg/day). For comparison, the DIIP study was also performed without bromocriptine treatment. In both cases, serum T4 and serum T3, which had decreased by, respectively, 34% +/- 5% and 17% +/- 5%, returned over the same time interval to their initial values. Serum TSH and TRH-mediated TSH secretion were also unaffected by the bromocriptine treatment. DIIP does not interfere in the serum determination of T3, T4 and rT3. During suppression with DIIP serum T3 fell less than serum T4 and returned more rapidly to its initial concentrations. It is concluded that dopaminergic inhibition by bromocriptine, at this dose, is insufficient to alter normal thyroid function. In addition, during suppression and shortly thereafter there is a tendency for the serum T3 levels to be maintained.

Effect of the combination of dexamethasone and sodium ipodate on serum thyroid hormones in Graves' disease

To investigate the effect of the combination of dexamethasone (Dex) and sodium ipodate (SI) on hyperthyroidism, we studied 24 patients with typical Graves' disease, divided into four groups of six persons each. Three groups (Study I) were studied acutely (24 h) to determine the effects of Dex (5 mg every 12 h intramuscularly), SI (one oral dose of 3 g) and both drugs at the same doses, upon T4, T3, and rT3 at 0900 h before therapy was started and 24 h later. The group on Dex and that on SI had a similar T3 decrement of 25.9 +/- 4.0% and 35.8 +/- 5.0%, respectively, (P less than 0.05), whereas the effect of both drugs combined was greater (64.2 +/- 3.6%; P less than 0.01, Dex, and P less than 0.01, SI, respectively). The increment of rT3 was markedly greater in those patients on SI than in those on Dex (561.3 +/- 149.2% and 58.9 +/- 11%, respectively, P less than 0.025). A fourth group (Study II) was studied for seven days while receiving both Dex (1 mg orally three times per day) and SI (500 mg orally three times per day). Both T4 (from 18.8 +/- 1.1 to 13.1 +/- 1.1 micrograms/dl, P less than 0.02) and T3 (from 593 +/- 41 to 136.3 +/- 12.7 ng/dl, P less than 0.001) decreased at day 8. The initial brisk increment of rT3 at 24 h (808 +/- 149%, P less than 0.005) then diminished concomitantly with the fall of its precursor, T4.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroid function tests in thyroid and nonthyroid disease

Modern day evaluation of thyroid disorders requires a combination of accurate clinical judgement and reliable, sensitive, and specific thyroid functions tests. Principle among the latter are thyroxine (T4) 3, 5, 3'-triiodothyronine (T3), and thyroid-stimulating hormone (TSH). Also playing an important role in special situations are free thyroxine, an assessment of bound and unbound thyroid-binding globulin, TRH stimulation, long-acting thyroid stimulator (LATS), antibodies to thyroid hormone and to thyroid receptors. Basic to interpretation of these tests in the clinical setting is a comprehension of the relationship of the hypothalamus, the pituitary, and the thyroid gland as well as a knowledge of the peripheral metabolism of thyroxine and triiodothyronine. The role of each of these laboratory tests in the evaluation of hyper- and hypometabolic states, their alteration in nonthyroid and other endocrine disorders, and the effects of environmental and physiological factors on these tests are reviewed.

Bromocriptine therapy in acromegaly. A long-term review of 35 cases

Bromocriptine (CB-154, Parlodel, Sandoz) was given to 35 acromegalic patients for a period of 6-36 months. Basal and post-therapy endocrine functions including estimation of serum growth hormone (GH) profile; and GH kinetics during oral glucose tolerance test, augmented insulin tolerance test and thyrotrophin releasing hormone test were determined. The pituitary tumour size was delineated by a pneumoencephalogram. The mean GH levels ranged from 14 micrograms/l to 316 micrograms/l. Bromocriptine suppressed GH values to 5 micrograms/l or less in 16 patients and less than 10 micrograms/l in a further 6 patients. In 33 patients GH values fell to 50% of the basal value or less. There was no significant GH reduction in 2 'nonresponders'. Bromocriptine did not block the stress-induced GH secretion. It did not disturb pituitary functions other than prolactin which was suppressed much earlier and was maintained with smaller doses. GH suppression on the other hand was shortlived and rebounded when the drug was omitted. It had no adverse effect on tumour size in 2 patients having suprasellar extension of the tumour. Bromocriptine improved carbohydrate tolerance and sexual function although it did not affect insulin and gonadotrophin values. It seems reasonable to offer a trial of bromocriptine in all patients with acromegaly where therapy is deemed necessary as it is well tolerated, has insignificant side effects and no adverse drug interactions. Its high cost and prolonged course are obvious disadvantages. Caution should be exercised in cases with suprasellar extension and visual field involvement.

Radioimmunoassay of triiodothyronine and thyroxine in capillary blood

A radioimmunoassay technique for the estimation of T3 and T4 levels in capillary blood is described and evaluated in comparison to a simultaneously drawn and equally analyzed sample from the cubital vein. A total number of 236 samples thus received from the capillary and the vein from euthyroid, hypo- and hyper-thyroid patients were collected. For both T3 and T4 a good correlation (r = 0.94) was obtained. The clinical implication would especially be for paediatric practice.

Automated tests for the assessment of thyroid function

Fully automated methods have been developed for the determination of thyroxine and triiodothyronine levels, antibodies to thyroglobulin and the assessment of thyroid hormone binding proteins in serum, using a continuous flow radioimmunoassay system. In addition the feasibility of a partially automated assay for thyrotrophin levels has been demonstrated. These employ Auto Analyzer modules and antibodies covalently linked to a magnetisable solid phase support. Separation of bound and free antigen is achieved by applying an external magnetic field. The system currently operates at a rate of 30 samples/h and requires only 10 minutes incubation since it is not necessary to reach equilibrium. The results are similar to those obtained by conventional manual techniques, however the precision is improved and operator error eliminated.

A radioimmunoassay for thyroxine on Sephadex columns. Investigations on the influence of some buffers on the binding of thyroxine to serum proteins

A thyroxine radioimmunoassay procedure (T4RIA) based on incubation and separation on Sephadex columns is presented. The assay is rapid and easily to perform; if necessary columns may be regenerated. The raising of antibodies against thyroxine in goats is described in detail. The specificity of the antiserum towards the coupling of several compounds related to thyroxine has been tested. Influence of some buffers on the binding of thyroxine to serum proteins has been investigated. The results of T4RIA in patient sera were in agreement with those obtained by a competitive binding method. The within-day variation was approximately 4% (coefficient of variation, C.V.); day-to-day variation was 7% C.V.

T3 toxicosis in children

Triiodothyronine (T3) toxicity has been well documented in adults, but only isolated cases have been reported in children. Two girls presented with firm goitres and overt hyperthyroidism. In each patient, total serum thyroxine (T4) values by competitive protein binding were normal, however total T3 values by radioimmunoassay were elevated. One patient had Graves' disease, the second patient had Hashimoto's disease which has been only infrequently associated with T3 toxicity in adults. Both patients responded to therapy with propylthiouracil. The mechanisms by which T3 is preferentially secreted in thyrotoxic states in man are poorly understood, but iodine deficiency and poor iodination of thyroglobulin may be important factors.

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.

Reassessment of the daily dose of oral thyroxine for replacement therapy in hypothyroid children

The optimal daily requirement of sodium L-thyroxine for replacement therapy of hypothyroidism was evaluated in 11 hypothyroid children ranging from one to 14 years of age. The "optimal" dose of L-T4, defined as the minimal daily dose necessary to suppress the serum concentration of TSH to normal, was determined in each patient and individual growth rates were assessed for periods up to 12 months during the time this dose was being administered. The mean "optimal" dose of L-T4 was 3.78 +/- 0.6 mug/kg or 104.6 +/- 5.2 mug/m2. This dose was considerably lower than the doses of L-T4 generally recommended. All patients appeared clinically euthyroid, and their serum concentrations of T3 and T4 as well as their height velocities remained within the normal range while the "optimal" dose of L-T4 was being adminstered.

Solid-phase radioimmunoassay of plasma triiodothyronine

A direct radioimmunoassay method for circulating triiodothyronine was set up, using an insolubilized (cellulose-coupled) antiserum and 8-anilino-1-naphthalene-sulfonic acid (ANS) as a protein inhibitor. Particular attention was paid to the evaluation of changes in the physico-chemical properties of the antibody sites under the experimental conditions adopted: no substantial decrease of immunoreactivity was found to be associated with the insolubilization process, while complex effects following the use of protein inhibitors were observed. The standardized procedure was defined in terms of analytical reliability both by a comparison with a reference (charcoal-dextran) method and by evaluation of sensitivity, precision and accuracy.

Serum triiodothyronine determination in clinical use

Two radioimmunassays for the determination of serum triiodothyronine (T3) were developed. The assay of T3 in unextracted serum had several advantages over the assay on extracted serum and was chosen for the routine determination of T3 in serum from 117 patients requiring assessment of their thyroid status. In 53 subjects considered retrospectively not to have thyroid dysfunction nor to have been on steroid contraceptives or therapy, the pooled mean serum T3 concentration was 1-92 (actual range 0-88-2-62) nmol/l. A significant inverse relationship was observed between the serum T3 level and the age of the subject. Serum total T3 levels discriminate clearly between hypo-,eu- and hyperthyroid patients and provide a rather more sensitive index of hyperthyroid function than total serum T4. In the face of normal serum T4 the T3 level was depressed in five patients with marked hypoproteinaemia and elevated in two patients taking heroin.

Reduced peripheral conversion of thyroxine to triiodothyronine in patients with hepatic cirrhosis

The role of liver in the peripheral conversion of thyroxine (T4) to triiodothyronine (T3) was studied in normal subjects and patients with alcoholic liver disease by measurement of thyrotrophin (TSH) and total and free T4 and T3 in randomand serial serum samples. Also, T4 to T3 conversion rates and T3 disposal rates were compared by noncompartmental analysis. While the mean total serum T4 values were similar for the two groups, 8.6 and 8.1 mug/kl, the mean free T4 value was significantly higher in the cirrhotic patients (3.3 ng/dl) than in the normal subjects (2.1 ng/dl, P less than 0.001). The mean serum T3 value, 85 ng/dl, was significantly reduced in the hepatic patients as compared to a mean serum T3 value of 126 ng/dl in the normal subjects (P less than 0.001), while the free T3 value was 0.28 ng/dl in both groups. The reduction of the serum total and free T3 values were closely correlated with the degree of liver damage, as indicated by elevation of serum bilirubin (r equal -0.547) and reduction of serum albumin (r equal 0.471). The mean serum TSH level was 3.1 muU/ml in the normals and 7.1 muU/ml in the cirrhotic aptients ( less than 0.001). 15% of the hepatic patients had serum TSH values above 10 muU/ml, which, however, did not correlate with any of the four liver function tests studied. Serial blood sampling from two convalescing patients with alcoholic hepatitis showed a gradual normalization of serum TSH and T3 levels as the liver function improved. After oral T4 administration, 0.25 mg/day for 10 days, three of four cirrhotic patients studied failed to raise their serum T3 values. The mean T4 to T3 conversion rate of seven normal subjects was 35.7%. The mean T4 to T3 conversion rate of four cirrhotic patients studied was significantly reduced to 15.6% (P less than 0.001). The mean disposal rates of T4 and T3 of the normal subjects were 114 and 34 mug/day, respectively. The ratio of T4 disposal to T3 disposal was 3.5. In contrast, the mean T4 disposal rate, 82 mug/day, and the mean T3 disposal rate, 10 mug/day, were both reduced in the cirrhotic patients. Their ratio of T4 disposal to T3 disposal was 7.9. These findings suggest that impairment of T4 conversion in patients with advanced hepatic cirrhosis may lead to reduced T3 production and lowered serum T3 level. Therefore, the liver is one of the major sites of T4 conversion to T3.

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.