Nuklearmedizin 1985; 24(03): 115-121
DOI: 10.1055/s-0038-1624289
Short Communications – Kurzmitteilungen
Schattauer GmbH

The Evaluation of Free Thyroid Hormones (FT4 and FT3) in the Routine Diagnosis of Thyroid Function

Bewertung der freien Schilddrüsenhormone (FT4 und FT3) in der Schilddrüsen- Funktionsroutinediagnostik
A Passath
1   From the Medizinische Universitätsklinik (Vorstand: Prof. Dr. S. Sailer), Graz, Austria
,
G. Leb
1   From the Medizinische Universitätsklinik (Vorstand: Prof. Dr. S. Sailer), Graz, Austria
,
R. Goebel
1   From the Medizinische Universitätsklinik (Vorstand: Prof. Dr. S. Sailer), Graz, Austria
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 10. September 1984

14. März 1985

Publikationsdatum:
20. Januar 2018 (online)

Summary

The validity of the free thyroid hormone parameters (FT4 and FT3) was verified in a random sample of 154 ambulatory patients with thyroid conditions. The “euthyroid range” of FT4 was between 15.67 and 30.66 pmol/1; median 21.98 pmol/1. The distribution of the FT4 readings peaked on the left and sloped to the right (log normal). In our laboratory, the “euthyroid reference range” of FT4 is between 10-28 pmol/1. The “euthyroid range” of FT3 extended from 4.6 to 9.7 pmol/ 1; median 6.63 pmol/1. The distribution of the readings was likewise log normal. The values of FT4 and FT3 are not significantly influenced by TBG concentration anomalies in otherwise healthy thyroid patients. For purposes of discrimination between euthyroidism and hyperthyroidism, FT3 (95%) and FT4 (90%) are better suited than the corresponding quotients for the free hormone fraction or the total hormone concentrations. On the other hand, the free hormone parameters are less suitable for the diagnosis of hypothyroidism. These results were deduced theoretically from mathematical function analyses between the TBG-independent free hormone parameters and the TBG-dependent hormone concentrations.

Zusammenfassung

Anhand einer Stichprobe von 154 ambulanten Schilddrüsenpatienten wurde die Wertigkeit der freien Schilddrüsenhormonparameter (FT4 und FT3) überprüft. Der »Euthyreosebereich« des FT4 dieser Stichprobe war zwischen 15,67 und 30,66 pmol/1; Median 21,98 pmol/1 (95% Vertrauensbereich). Die Verteilung der FT4 Meßwerte war linksgipfelig und rechtsschief (lognormal). Der laboreigene »euthyreote Referenzbereich« des FT4 liegt zwischen 10 und 28 pmol/1. Der »Euthyreosebereich« des FT3 reichte von 4,6-9,7 pmol/1; Median 6,63 pmol/1. Die Verteilung der Meßdaten war ebenfalls lognormal. Die Meßergebnisse des FT4 und FT3 werden durch TBG-Konzentrationsanomalien bei ansonst gesunden Schilddrüsenpatienten nicht signifikant beeinflußt. Zur Diskriminierung zwischen einer Euthyreose und einer Hyperthyreose sind das FT3 (95%) und das FT4 (90%) besser geeignet als die entsprechenden Quotienten für den freien Hormonanteil bzw. die Gesamthormonkonzentrationen. Zur Diskriminierung einer Hypothyreose sind die freien Hormonparameter weniger geeignet. Diese Ergebnisse wurden anhand mathematischer Funktionsanalysen zwischen den TBG-unabhängigen freien Hormonparametern und den TBG-abhängigen Hormonkonzentrationen theoretisch abgeleitet.

 
  • References

  • 1 Amino N, Nishi K, Nakatani K, Mizuta H, Ichihara K, Tanizawa O, Miyai K. Effect of albumin concentration on the assay of serum free thyroxine by equilibrium radio-immunoassay with labeled thyroxine analog (Amerlex® free T4 ). Clin. Chem 1983; 29: 321-5.
  • 2 Chan D. W, Waud J. M, Hsu T. H. Clinical assessment of a radioimmunoassay for free thyroxine using a modified tracer. J. nucl. Med 1983; 24: 498-504.
  • 3 Ekins R. P, Edwards P, Newman B. The role of binding proteins in hormone delivery. In: Free Hormones in Blood. Albertini A, Ekins P. R. eds. 3-26 Elsevier Biomedical Press; Amsterdam: 1982
  • 4 Emrich D, Schöndube H, Schreivogel I, Schürnbrand P. Pathophysiological and clinical significance of free T4 . In: Free T4 – the Way Ahead in Thyroid Diagnosis. 1-8 The Medicine Publishing Foundation; Oxford, UK: 1982
  • 5 Franklyn J. A, Sheppard M. C, Ramsden D. B, Hoffenberg R. Free triiodothyronine and free thyroxine in sera of pregnant women and subjects with congenitally increased or decreased thyroxine- binding globulin. Clin. Chem 1983; 29: 1527-30.
  • 6 Helenius T, Liewendahl K. Improved dialysis method for free thyroxine in serum compared with five commercial radioimmunoassays in nonthyroidal illness and subjects with abnormal concentrations of thyroxin-binding globulin. Clin. Chem 1983; 29: 816-22.
  • 7 Hörst M, Woitzel I, Hohlweg-Majert P. FT4-measurement in late pregnancy. NUC-Comp 1982; 13: 184-7.
  • 8 Hoff H-G, Reinwein D. Assessment of thyroid status by FT4-concentration and T4/TBG ratio - Better discrimination of FT4 in patients with marked anomalies of TBG concentration. Nucl. Med 1982; 21: 192-4.
  • 9 Hotze A, Mahlstedt J, Wolf F. Arguments to measure free hormones in thyroid diagnostics. NUC-Comp 1983; 14: 208-16.
  • 10 Mahlstedt J, Müller W. Comparison of FT4 and total T4 estimates as single parameters in the evaluation of thyroid state. Nucl. Med 1982; 21: 195-9.
  • 11 Mahlstedt J. Measurement of free Ltriiodothyronine (FT3) in serum - Results of a multicentre trial. NUC-Comp 1983; 14: 280-97.
  • 12 Midgley J EM, Wilkens T. A, Giles A. F. Free serum thyroxine in T4 - treated patients. NUC-Comp 1981; 12: 106-10.
  • 13 Midgley J EM, Wilkins T. A. The Direct Estimation of Free Hormones by a Simple Equilibrium Radioimmunoassay. Amersham International. 1981
  • 14 Midgley J EM. Methodological background of the Amersham Amerlex free thyroxine RIA. Nucl. Med 1982; 21: 179-83.
  • 15 Midgley J EM, Wilkins T. A. An improved method for the estimation of relative binding constants of T4 and its analogues with serum proteins. Clin. Endocrinol 1982; 17: 523-8.
  • 16 Midgley J EM. Response of the thyroid to non-thyroidal illness. In: Free T4 – the Way Ahead in Thyroid Diagnosis. 29-36 The Medicine Publishing Foundation; Oxford, UK: 1982
  • 17 Passath A, Leb G, Goebel R, Warnkroß H. Two generations of FT4- radioimmunoassays - Results in euthyroid patients and in patients on thyroid hormone therapy. Nucl. Med 1982; 21: 200-8.
  • 18 Passath A, Leb G, Goebel R. Influence of thyroid hormone therapy on the free thyroxine level (FT4). NUCComp 1982; 13: 244-52.
  • 19 Passath A, Leb G, Goebel R. Comparison between two FT3- radioimmunoassay methods - Preliminary results. NUC-Comp 1983; 14: 177-83.
  • 20 Passath A, Leb G, Ollinger P. On the validity of FT4 values measured by radioimmunoassays. Klin. Wschr 1984; 62: 640-50.
  • 21 Prince H. P, Ramsden D. B. A new theoretical description of the binding of thyroid hormones by serum proteins. Clin. Endocrinol 1977; 07: 307-24.
  • 22 Ramsden D. B, Sheppard M. C, Sawers R. S, Smith S. C. H, Hoffenberg R. Serum free thyroxine concentrations in normal euthyroid subjects and ones with high serum thyroxine binding globulin concentration. Clin. Chim. Acta 1983; 130: 211-7.
  • 23 Stockigt J. R, Degaris M, Csicsmann J, Barlow J. W, Withe E. L, Hurley D. M. Limitation of a new free thyroxine assay (Amerlex® Free T4). Clin. Endocrinol 1981; 15: 313-8.
  • 24 Stockigt J. R, Stevens V, Withe E. L, Barlow J. W. “Unbound analog” radioimmunoassays for free thyroxine measure the albumin-bound hormone fraction. Clin. Chem 1983; 29: 1408-10.
  • 25 Wilke T. J, Sheedy T. J, Hirning D. A. Performance characteristics and diagnostic value (vs other tests) of two radioimmunoassay kits for estimating free triiodothyronine in serum. Clin. Chem 1984; 30: 216-21.
  • 26 Witherspoon L. R, Shuler St. E, Gilbert S. S. Evaluation of an immunoextraction procedure for the estimation of free thyroxine concentration. J. nucl. Med 1984; 25: 188-96.
  • 27 Withworth A. S, Midgley J. E. M, Wilkins T. A. A comparison of free T4 and the ratio of total T4 to T4-binding globulin in serum through pregnancy. Clin. Endocrinol 1982; 17: 307-13.