"Sensitive" thyrotropin (TSH), thyroglobulin (TG) and even thyrotropin binding inhibiting immunoglobulins (TBII) assays are now widely available. The objective of the present study was to determine the most accurate of these three parameters to predict the relapse of Graves' disease during the year following treatment discontinuation and to evaluate whether the assay of three markers is able to improve the prediction. TSH, TG and TBII were measured in the sera of 67 Graves' disease patients after at least 12 months of medical treatment. In 52 patients, TBII had also been determined before the beginning of the medical treatment. Under treatment, all the patients were clinically and biologically euthyroid, but in 9 goitrous patients it was impossible to lower the doses of carbimazole without an immediate relapse. The TSH levels of these 9 patients were still low in all cases but one; TG and TBII levels were abnormal in all. In the other 58 patients, the treatment was discontinued; 22 relapsed within one year, more frequently when a goiter was present. The most reliable parameter for the prediction of relapse was found to be TBII, as its specificity was high (94.5%), although its sensitivity was poor (45%); TG was more sensitive (64%) but far less specific (57%); TSH and "initial" TBII appeared to be of a little interest. When TBII was elevated prior to the withdrawal of treatment, the determination of TG was useful: abnormal values of both TBII and TG were always associated with a relapse. When TBII testing was negative, the relapse risk fell to 0.26, and to 0.08 when three criteria were matched: no goiter, negative TBII, normal TG.

We compared the diagnostic value of information given by total testosterone (I), free testosterone (II), the free androgen index (III), and testosterone not bound by sex-hormone-binding globulin (SHBG) (IV) as measured by a new differential ammonium sulfate precipitation technique, each step of which is conducted at 37 degrees C. SHBG and albuminemia were also measured. To examine the clinical value of IV, we analyzed single blood samples from 15 hirsute women and 15 age-matched healthy control volunteers. Values for I, II, III, and IV testosterone were all significantly higher in the hirsute group (P less than 0.01), whereas SHBG was decreased (P less than 0.01) and albumin concentrations were similar for the two groups. Overlap between values for normal and for hirsute women was 33.3% for I, 13.3% for II, and 0% for III and IV. The presented data suggest that IV measured by ammonium sulfate precipitation is the preferred discriminator for detecting hyperandrogenism, because this assay is technically simpler and less expensive than the II assay for routine investigation. It closely reflects the pool of bioavailable testosterone; thus, its main use might be as a screening test for androgen excess in women.

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Abstract. The serum concentrations of the different forms of circulating testosterone, total testosterone, free testosterone and non-sex-hormone binding globulin bound testosterone (albumin bound + free fractions) which is considered as the biovailable hormone, were measured in 15 hyperthyroid women before and after anti-thyroid drug therapy and in 15 age-matched healthy women. Sex-hormone binding globulin and albumin were quantified. Total testosterone was significantly higher in hyperthyroid women before treatment, whereas free testosterone and non sex-hormone binding globulin bound testosterone were significantly decreased. After recovery, all the parameters returned to the normal range. In hyperthyroid patients, the variations in the different fractions of testosterone can be related to the rise of sex-hormone binding globulin. These variations could be explained by the displacement of the equilibrium defined by the binding equation.

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