Research Article| Volume 4, ISSUE 4, P671-682, December 1984

Controversies in Thyroid Function Testing

      This paper is only available as a PDF. To read, Please Download here.
      Thyroid function tests can be abnormal in certain patients in the absence of thyroid dysfunction. All thyroid function tests can be affected in these patients, including the free thyroxine assays and free thyroxine index. Familiarity with the conditions affecting thyroid function tests is necessary to avoid incorrect diagnosis and unnecessary testing.
      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


        • Allen K.R.
        • Watson D.
        Thyrotropin as the initial screening test for thyroid disease.
        Clin. Chem. 1984; 30: 502-503
        • Amino N.
        • Nishi K.
        • Nakatani K.
        • et al.
        Effect of albumin concentration on the assay of serum free thyroxin by equilibrium radioimmunoassay with labeled thyroxin analog.
        Clin. Chem. 1983; 29: 321-325
        • Ashwell K.
        • Hopton M.R.
        • Hanop J.S.
        Serum free thyroxine concentrations in subjects with high circulating levels of thyroxine-binding globulin.
        Ann. Clin. Biochem. 1983; 20: 285-288
        • Borst G.C.
        • Eil C.
        • Burman K.D.
        Euthyroid hyperthyroxinemia.
        Ann. Intern. Med. 1983; 98: 336-378
        • Boss M.
        • Kingstone D.
        • Chan M.K.
        • et al.
        Contradictory finding in the measurement of free thyroxin after administration of heparin.
        Clin. Chem. 1982; 28: 1238-1239
        • Bunting J.
        Immunoassays for free hormone measurement.
        in: Albertini A. Ekins R.P. Free Hormones in Blood. Elsevier Biomedical Press, New York1982: 139-149
        • Buehler R.J.
        Applications of microencapsulated antibody in free hormone radioimmu noassay.
        in: Albertini A. Ekins R.P. Free Hormones in Blood. Elsevier Biomedical Press, New York1982: 121-127
        • Chan D.W.
        • Maud J.M.
        • Hsu T.H.
        Clinical assessment of a radioimmunoassay for free thyroxine using a modified tracer.
        J. Nucl. Med. 1983; 24: 498-504
        • Chopra I.J.
        • Solomon D.H.
        • Hepner G.W.
        • et al.
        Misleadingly low free thyroxine index and usefulness of reverse triiodothyronine measurement in non-thyroidal illnesses.
        Ann. Intern. Med. 1979; 90: 905-912
        • Chopra I.J.
        • Van Herle A.J.
        • Chuateco G.N.
        • et al.
        Serum free thyroxine in thyroidal and non-thyroidal illnesses: A comparison of measurements by radioimmunoassay, equilibrium dialysis and free thyroxine index.
        J. Clin. Endocrinol. Metab. 1980; 51: 135-143
        • Chopra I.J.
        • Hershman J.M.
        • Pardridge W.M.
        • et al.
        Thyroid function in nonthyroid illnesses.
        Ann. Intern. Med. 1983; 98: 946-957
        • Ekins R.
        • Edwards P.
        • Jackson T.
        • et al.
        Interpretation of labeled-analog free hormone assay.
        Clin. Chem. 1984; 30: 491-493
        • Gooch B.R.
        • Isley W.L.
        • Utiger R.D.
        Abnormalities in thyroid function tests in patients admitted to a medical service.
        Arch. Intern. Med. 1982; 142: 1801-1805
        • Helenius T.
        • Liewendahl K.
        Improved dialysis method for free thyroxin in serum compared with five commercial radioimmunoassays in non-thyroidal illness and subjects with abnormal concentrations of hydroxin-binding globulin.
        Clin. Chem. 1983; 29: 816-822
        • Kaplan M.M.
        • Larsen P.R.
        • Crantz F.R.
        • et al.
        Prevalence of abnormal thyroid function test results in patients with acute medical illnesses.
        Am. J. Med. 1982; 72: 9-16
        • Kaptein E.M.
        • Maclntype S.S.
        • Weiner J.M.
        • et al.
        Free thyroxine estimates in non-thyroidal illness: Comparison of eight methods.
        J. Clin. Endocrinol. Metab. 1981; 52: 1073-1077
        • Kramlinger K.
        • Gharib H.
        • Swanson D.W.
        • et al.
        Normal serum thyroxine values in patients with acute psychiatric illness.
        Am. J. Med. 1984; 76: 799-801
        • Kubasik N.P.
        • Same D.G.
        • Brodows R.G.
        • et al.
        Assay of thyrotropin in hyperthyroidism.
        Clin. Chem. 1983; 29: 1688
        • Kubasik N.P.
        • Lundberg P.
        • Brodows R.G.
        • et al.
        Free thyroxine by radioimmunoassay.
        Clin. Chem. 1983; 29: 1780-1781
        • Levy R.P.
        • Jensen J.B.
        • Laus V.G.
        • et al.
        Serum thyroid hormone abnormalities in psychiatric disease.
        Metabolism. 1981; 30: 1060-1064
        • Lundberg P.
        • Jagenburg R.
        • Lindstedt G.
        • et al.
        Heparin in vivo effect on free thyroxin.
        Clin. Chem. 1982; 28: 1241-1242
        • Midgley J.E.M.
        • Wilkins T.A.
        Effect of albumin concentrations on equilibrium radioimmunoassay of serum free thyroxin with labeled thyroxin analog (Amerlex free T4).
        Clin. Chem. 1983; 29: 1861-1863
        • Morley J.E.
        • Slag M.F.
        • Elson M.K.
        • et al.
        The interpretation of thyroid function tests in hospitalized patients.
        J.A.M.A. 1983; 249: 2377-2379
        • Musto J.D.
        • Pizzolante J.M.
        • Chesarone V.P.
        A comment on thyrotropin measurement and evaluation.
        Clin. Chem. 1984; 30: 329-330
        • Odstruchel G.
        A kinetic method for the measurement of free thyroxine and its application in the diagnosis of various thyroid disease states.
        in: Albertini A. Ekins R.P. Free Hormones in Blood. Elsevier Biomedical Press, New York1982: 91-105
        • Ooi D.S.
        • Sorisky A.
        Effect of albumin on results of analog-type assays for thyroxin.
        Clin. Chem. 1984; 30: 1109-1110
        • Ordonez-Llanos J.
        • Rodriguez-Espinosa J.
        • Gomez-Geniquo J.A.
        • et al.
        Effect of isolated decreases in albumin and prealbumin on radioimmunoassay results for free thyroxin in non-thyroidal illness.
        Clin. Chem. 1984; 30: 496-498
        • Rajatanavin R.
        • Fournier L.
        • De Cosimo D.
        • et al.
        Elevated serum free thyroxin by thyroxine analog radioimmunoassays in euthyroid patients with familial dysalbuminemic hyperthyroxinemia.
        Ann. Intern. Med. 1982; 97: 865-866
        • Shah V.D.
        • Shah N.V.
        Measurement of free thyroxin in patients with familial dysalbuminemic hyperthyroxinemia.
        Clin. Chem. 1984; 30: 579
        • Slag M.F.
        • Morley J.E.
        • Elson M.K.
        • et al.
        Free thyroxine levels in critically ill patients.
        J.A.M.A. 1981; 246: 2702-2706
        • Solomon D.H.
        • Benotti J.
        • De Groot J.J.
        • et al.
        Revised nomenclature for tests of thyroid hormones in serum.
        J. Clin. Endrinol. Metab. 1976; 42: 595-598
        • Spratt D.I.
        • Pont A.
        • Miller M.B.
        • et al.
        Hyperthyroxinemia in patients with acute psychiatric disorders.
        Am. J. Med. 1982; 73: 41-48
        • Stoekigt J.R.
        • De Ganis M.
        • Csicsmann J.
        • et al.
        Limitations of a new free thyroxine assay (Amerlex free T4).
        Clin. Endocrinol. 1981; 15: 313-318
        • Stoekigt J.R.
        • Stevens V.
        • White E.L.
        • et al.
        “Unbound analog” radioimmunoassays for free thyroxin measure the albumin bound hormone fration.
        Clin. Chem. 1983; 29: 1408-1410
        • Stoekigt J.R.
        • Lim C.
        • Barlow J.W.
        • et al.
        High concentrations of furosemide inhibit serum binding of thyroxine.
        J. Clin. Endocrinol. Metab. 1984; 59: 62-65
        • Van de Vyver F.L.J.
        • Kruse J.
        • Muylle L.
        • et al.
        Free thyroid hormone estimates related to measurements of total serum hormone levels and free thyroid hormone indices.
        Clin. Chem. 1983; 29: 1866-1867
        • Wartofsky L.
        • Burman K.D.
        Alterations in thyroid function in patients with systemic illness: The “euthyroid sick syndrome.”.
        Endocrine Rev. 1982; 3: 164-217
        • Wand J.M.
        • Chan D.W.
        • Drew H.M.
        • et al.
        Clinical evaluation of two direct procedures for free thyroxin and of free thyroxin index determined non-isotopically and by measuring thyroxin-binding globulin.
        Clin. Chem. 1983; 29: 1908-1911
        • Wilke T.J.
        Five kits for estimating free thyroxin concentration in serum evaluated and correlated with other indices to thyroid status.
        Clin. Chem. 1982; 28: 2051-2056
        • Willkins T.A.
        • Midgley J.E.M.
        Interpretation of free thyroxine radioimmunoassay data.
        Lancet. 1982; 2: 324
        • Witherspoon L.R.
        • Schuler S.E.
        • Gilbert S.S.
        Estimation of free thyroxin with a new thyroxin analog and a porous glass solid phase.
        Clin. Chem. 1984; 30: 778-781
        • Wong E.T.
        • Bondley S.G.
        • Schultz A.L.
        Elevations of thyroid-stimulating hormone during acute non-thyroidal illness.
        Arch. Intern. Med. 1981; 141: 873-875