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Nuklearmedizin 1988; 27(01): 24-28
DOI: 10.1055/s-0038-1628906
Originalarbeiten — Original Articles
Schattauer GmbH

Highly Sensitive Determination of TSH in the Follow-Up of TSH-Suppressive Therapy of Patients with Differentiated Thyroid Cancer

K. Mann
2   Klinikum Großhadern, University of Munich, FRG
,
B. Sailer
2   Klinikum Großhadern, University of Munich, FRG
,
U. Mehl
2   Klinikum Großhadern, University of Munich, FRG
,
R. Hörmann
2   Klinikum Großhadern, University of Munich, FRG
,
E. Moser
*   From the Department of Internal Medicine II and the Department of Radiology
› InstitutsangabenThe authors wish to thank Dr. K. Siddle, Department of Clinical Chemistry, University of Cambridge, Addenbrooke’s Hospital for his gift of monoclonal antibodies for TSH IRMA, Dr. Ch. Seidel (Henning, Berlin) for providing TSH IRMAclon kits, Prof. Dr. D. Neumair, Department of Clinical Chemistry, Klinikum Großhadern, University of Munich for the determinations of TT3, TT4 and thyroglobulin, and Mrs. Oberniedermayr for technical help.
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Publikationsverlauf

Received: 15. August 1987

25. November 1987

Publikationsdatum:
04. Februar 2018 (online)

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Basal and TRH-stimulated TSH levels were determined in 72 patients with differentiated thyroid cancer on hormonal treatment, using a highly sensitive immunoradiometric assay (IRMAclon, Henning). 43 patients were under treatment with levothyroxine (T4), 29 patients with triiodothyronine (T3). In 33/43 patients (77%) under T4- and in 18/29 patients (62%) under T3-treatment basal TSH levels were below 0.1 mU/l and levels stimulated with 200 µg TRH i.v. were below 0.5 mU/l. 3 patients showed a significant response (to above 0.5 mU/l) in the TRH test despite basal values of less than 0.1 mU/l. In 2 patients with elevated basal TSH levels (0.23 and 0.60 mU/l, resp.) in the IRMAclon, total suppression of TSH secretion was suggested by a failure of TSH to rise after TRH. By retesting these samples in an own TSH IRMA, basal and stimulated TSH values were below 0.1 mU/l. In conclusion, basal and TRH-stimulated TSH levels are well correlated in most patients with thyroid cancer under hormonal treatment. However, in some cases (5/72) determination of basal TSH could not clearly define the degree of thyrotropic suppression. Thus, TRH testing is still necessary to establish definitely complete TSH suppression in patients with thyroid carcinoma under suppressive treatment.

Zusammenfassung

Bei 72 ablativ behandelten Patienten mit differenziertem Schilddrüsenkarzinom, die unter einer TSH-suppressiven Hormontherapie standen, wurde TSH vor und nach Stimulation mit TRH (200 µg, i.V., 30 min) mit einem sensitiven immunoradiometri- schen Test (IRMAclon, Fa. Henning) bestimmt. 43 Patienten standen unter einer Therapie mit Levothyroxin (T4), 29 Patienten unter einer Therapie mit Trijodthyronin (T3). 33/43 Patienten (77%) der T4-Gruppe und 18/29 Patienten (62%) der T3-Gruppe hatten basale TSH-Spiegel <0.1 mU/1 und stimulierte TSH-Spiegel <0.5 mU/l. 3 Patienten stiegen trotz eines Basalspiegels <0.1 mU/l im TRH-Test signifikant auf >0.5 mU/l an. 2 Patienten mit basalen Spiegeln >0.1 mU/l im TSH-IRMAclon zeigten keinen Anstieg im TRH-Test. Bei Retestung dieser Serumproben in einem eigenen TSH-IRMA lagen sowohl die basalen als auch die stimulierten TSH-Spiegel <0.1 mU/l. Zusammenfassend fand sich bei den meisten Patienten unter Hormontherapie eines ablativ behandelten Schilddrüsenkarzinoms eine gute Korrelation von basalen und TRH-stimulierten TSH-Spiegeln. In einigen Fällen (5/72) jedoch zeigte die Bestimmung des basalen TSH das Ausmaß der TSH-Suppression nicht richtig an. So erscheint zum sicheren Nachweis einer vollständigen TSH- Suppression bei Patienten mit Schilddrüsenkarzinom unter Hormontherapie auch weiterhin die Durchführung eines TRH-Tests unerläßlich.

 

  • REFERENCES

  • 1 Busnardo B. Hormonal treatment of thyroid cancer. In: Jaffiol C, Milhaud G. eds. Thyroid cancer. Amsterdam: Elsevier: 1985: 229-33.
    Suche in Google Scholar
  • 2 Bernutz C, Horn K, König A, Pickardt C R. Advantages of sensitive assays for thyrotropin in the diagnosis of thyroid disorders. J Clin Chem Clin Biochem 1985; 23: 851-6.
    PubMedSuche in Google Scholar
  • 3 Caldwell G, Gow S M, Sweeting V M, Kellett H A, Beckett G J, Seth J. A new strategy for thyroid function testing. Lancet 1985; 01: 1117-9.
    Suche in Google Scholar
  • 4 Caldwell G, Gow S M, Sweeting V M, Beckett G J, Seth J, Toft A D. Value and limitations of a highly sensitive immunoradiometric assay for thyrotropin, in the study of thyrotropic function. Clin Chem 1987; 33: 303-5.
    PubMedSuche in Google Scholar
  • 5 Clark P M, Raggatt P R, Price C P. Antibodies interfering in immunometric assays. Clin Chem 1985; 31: 176-2.
    Suche in Google Scholar
  • 6 Cobb W E, Lamberton R P, Jackson I M D. Use of rapid, sensitive immunoradiometric assay for thyrotropin to distinguish normal from hyperthyroid subjects. Clin Chem 1984; 30: 1558-60.
    PubMedSuche in Google Scholar
  • 7 Dralle H, Böcker W, Hirthe C. et al. Thyroglobulin synthesis and secretion by xeno- transplanted human thyroid adenomas and differentiated carcinomas endogenously stimulated with TSH. Ann d’Endocrinol 1982; 43: 78A.
    Suche in Google Scholar
  • 8 Gardner D F, Rothmann J, Utiger R D. Serum thyroglobulin in normal subjects and hyperthyroidism due to Graves’ disease: Effects of T3, iodide, 131I and antithyroid drugs. Clin Endocrinol (Oxf) 1979; 11: 585.
    CrossrefPubMedSuche in Google Scholar
  • 9 Hamburger J I, Meier D A, Szupunar W E. Facticious elevation of thyrotropin in euthyroid patients. New Engl J Med 1985; 313: 267-8.
    PubMedSuche in Google Scholar
  • 10 Keller H. Ersetzt die Bestimmung der basalen TSH-Konzentration den TRH-Test?. Schweiz Med Wschr 1986; 116: 1009-15.
    PubMedSuche in Google Scholar
  • 11 Lamberg B A, Helenius T, Liewendahl K. Assessment of thyroxine suppression in thyroid carcinoma patients with a sensitive immunoradiometric assay. Clin Endocrinol 1986; 25: 259-63.
    CrossrefPubMedSuche in Google Scholar
  • 12 Martino E, Bambini G, Bartalena L. et al. Human serum thyrotrophin measurement by ultrasensitive immunoradiometric assay as a first-line test in the evaluation of thyroid function. Clin endocrinol 1986; 24: 141-8.
    CrossrefPubMedSuche in Google Scholar
  • 13 Mazzaferri E L. Papillary and follicular thyroid cancer: A selective approach to diagnosis and treatment. Ann Rev Med 1981; 32: 73-91.
    CrossrefPubMedSuche in Google Scholar
  • 14 Moser E, Fritsch S. Radiojodtherapie und Nachsorge des Schilddrüsen-Karzinoms. In: Engelhardt D, Mann K. (Hrsg.). Endokrinaktive maligne Tumoren. Berlin – Heidelberg – New York: Springer: 1987: 100-8.
    Suche in Google Scholar
  • 15 Nataf R T. Experimental research on thyroid cancer. Review of literature. Ann Radiol (Paris) 1977; 20: 703-14.
    PubMedSuche in Google Scholar
  • 16 Pearce C J, Himsworth R L. Total and free thyroid hormone concentrations in patients receiving maintenance replacement treatment with thyroxine. Br Med J 1984; 288: 693-5.
    CrossrefPubMedSuche in Google Scholar
  • 17 Rodriquez-Espinosa J, Ordonez-Llanos J, Mora-Brugues J, Lopez-Callul C, Cortes-Rius M. Sensitive immunoradiometric assay (IRMA) for serum thyrotropin may be insufficient to make the thyrotropin-releasing factor test unnecessary. Clin Chem 1985; 31: 1081-2.
    PubMedSuche in Google Scholar
  • 18 Seth J, Kellett H A, Caldwell G. et al. A sensitive immunoradiometric assay for serum thyroid stimulating hormone: A replacement for the thyrotropin releasing hormone test?. Br Med J 1984; 289: 1334-6.
    CrossrefPubMedSuche in Google Scholar
  • 19 Spencer C A, Lai-Rosenfeld A O, Guttler R B. et al. Thyrotropin secretion in thyrotoxic and thyroxine-treated patients: Assessment by a sensitive immunoenzymometric assay. J Clin Endocrinol Metab 1986; 63: 349-55.
    CrossrefPubMedSuche in Google Scholar
  • 20 Soos M, Taylor S J, Gard T, Siddle K. A rapid, sensitive two-site immunoradiometric assay for TSH using monoclonal antibodies: Investigation of factors affecting optimisation. J Immunol Meth 1984; 73: 237-49.
    CrossrefPubMedSuche in Google Scholar
  • 21 Westermark B, Karlsson F A, Walinder O. Thyrotropin is not a growth factor for human thyroid cells in culture. Proc Natl Acad Sei USA 1979; 76: 2022-6.
    CrossrefPubMedSuche in Google Scholar