Research Article| Volume 13, ISSUE 3, P673-682, September 1993

Download started.


Role of Thyrotropin Measurements in the Diagnosis and Management of Thryoid Disease

      This paper is only available as a PDF. To read, Please Download here.
      This article reviews the role of thyrotropin assays in clinical medicine and illustrates the advantages and limitations of assays that can measure subnormal concentrations. Analytic considerations that can significantly alter the performance of these assays are outlined. The concept of assay generations is defined, and the potential roles of third and fourth generation assays are postulated. In addition, a diagnostic strategy is presented for using TSH and other procedures in the diagnosis and management of thyroid disease.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Beckers A.
        • Abs R.
        • Mahler C.
        • et al.
        Thyrotropin-secreting pituitary adenomas: Report of seven cases.
        Clin Endocrinol Metab. 1991; 72: 477
        • Finucane P.
        • Rudra T.
        • Hsu R.
        • et al.
        Thyrotropin response to thyrotropin-releasing hormone in elderly patients with and without acute illness.
        Age Ageing. 1991; 20: 85
        • Gaines-Das R.E.
        • Brettschneider H.
        • Bristow A.F.
        The effects of common matrices for assay standards on performance of ultrasensitive immunometric assays for TSH.
        Clin Chim Acta. 1991; 203: S5
        • Geshundheit N.
        • Petrick P.A.
        • Nissim M.
        • et al.
        Thyrotropin-secreting pituitary adenomas: Clinical and biochemical heterogeneity.
        Ann Intern Med. 1989; 111: 827
        • Gharib H.
        • James E.M.
        • Charboneau J.W.
        • et al.
        Suppressive therapy with levothyroxine for solitary thyroid nodules: A double-blind controlled clinical study.
        N Engl J Med. 1987; 317: 70
        • Gordin A.
        • Lamberg B.A.
        Spontaneous hypothyroidism in symptomless autoimmune thyroiditis. A long-term follow-up study.
        Clin Endocrinol. 1981; 15: 537
        • Gow S.M.
        • Caldwell G.
        • Toft A.D.
        • et al.
        Restoration of normal thyrotrophin secretion reduced the abnormally high serum glutathione S-transferase levels found in patients receiving thyroxine replacement therapy.
        Clin Endocrinol. 1988; 29: 249
        • Hay I.D.
        • Bayer M.F.
        • Kaplan M.M.
        • et al.
        American Thyroid Association assessment of current free thyroid hormone and thyrotropin measurements and guidelines for future clinical assays.
        Clin Chem. 1991; 37: 2002
        • Isojärvi J.I.T.
        • Pakarinen A.J.
        • Myllylä V.V.
        Thyroid function with antiepileptic drugs.
        Epilepsia. 1992; 33: 142-148
        • Klee G.G.
        • Hay I.D.
        Assessment of sensitive thyrotropin assays for an expanded role in thyroid function testing: Proposed criteria for analytic performance and clinical utility.
        J Clin Endocrinol Metabol. 1987; 64: 461
        • Larkin J.G.
        • Macphee G.J.A.
        • Beastall G.H.
        • et al.
        Thyroid hormone concentrations in epileptic patients.
        Eur J Clin Pharmacol. 1989; 36: 213
        • Liewendahl K.
        • Helenius T.
        • Lamberg B.A.
        • et al.
        Free thyroxine, free triiodothyronine, and thyrotropin concentrations in hypothyroid and thyroid carcinoma patients receiving thyroxine therapy.
        Acta Endocrinol. 1987; 116: 418
        • Maes M.
        • Vandewoude M.
        • Maes L.
        • et al.
        A revised interpretation of the TRH test results in female depressed patients.
        J Affective Disord. 1989; 16: 203
        • McClelland P.
        • Scott A.
        • Howel-Evans W.
        Hyperthyrotrophinaemia during thyroxine replacement therapy.
        Postgrad Med J. 1989; 65: 205
        • Nicoloff J.T.
        • Spencer C.A.
        The use and misuse of the sensitive thyrotropin assays.
        J Clin Endocrinol Metab. 1990; 71: 553
        • Price D.E.
        • O’Malley B.P.
        • Northover B.
        • et al.
        Changes in circulating thyroid hormone levels and systolic time intervals in acute hypothyroidism.
        Clin Endocrinol. 1991; 35: 67
        • Reverter J.L.
        • Lucas A.
        • Salinas I.
        • et al.
        Suppressive therapy with levothyroxine for solitary thyroid nodules.
        Clin Endocrinol. 1992; 36: 25
        • Roca R.P.
        • Blackman M.R.
        • Ackerley M.B.
        • et al.
        Thyroid hormone elevations during acute psychiatric illness: Relationship to severity and distinction from hyperthyroidism.
        Endocr Res. 1990; 16: 415
        • Roden M.
        • Nowotny P.
        • Vierhapper H.
        • et al.
        Diagnostic relevance of suppressed basal concentrations of TSH compared with the negative TRH test in detection and exclusion of hyperthyroidism.
        Acta Endocrinol (Copenh). 1991; 124: 136
        • Rupprecht R.
        • Rupprecht C.
        • Rupprecht M.
        • et al.
        Triiodothyronine, thyroxine, and TSH response to dexamethasone in depressed patients and normal controls.
        Biol Psychiatry. 1989; 25: 22
        • Spencer C.A.
        • LoPresti J.S.
        • Patel A.
        • et al.
        Applications of a new chemiluminometric thyrotropin assay to subnormal measurement.
        J Clin Endocrinol Metab. 1990; 70: 453
        • Stall G.M.
        • Harris S.
        • Sokoll L.J.
        • et al.
        Accelerated bone loss in hypothyroid patients overtreated with L-thyroxine.
        Ann Intern Med. 1990; 113: 265
        • Tunbridge W.M.
        • Brewis M.
        • French J.M.
        • et al.
        Natural history of autoimmune thyroiditis.
        Br Med J. 1981; 282: 258
        • Vanelle J.M.
        • Poirier M.F.
        • Benkelfat C.
        • et al.
        Diagnostic and therapeutic value of testing stimulation of thyroid-stimulating hormone by thyrotropin-releasing hormone in 100 depressed patients.
        Acta Psych Scand. 1990; 81: 156
        • Zweig M.H.
        • Csako G.
        High-dose hook effect in a two-site IRMA for measuring thyrotropin.
        Ann Clin Biochem. 1990; 27: 494
        • Zweig M.H.
        • Csako G.
        • Reynolds J.C.
        • et al.
        Interference by iatrogenically induced anti-mouse IgG antibodies in a two-site immunometric assay for thyrotropin.
        Arch Pathol Lab Med. 1991; 115: 164