The role of precision in determining the performance of a thyrotropin assay in diagnosing hyperthyroidism.

Wilke, T J; Utley, D J

doi:10.1093/clinchem/34.7.1464

Cited by 5 publications

(1 citation statement)

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“…Further discrimination between the TSH assays has been performed on the base of the detection limits of the various assays (Wood et al, 1985, Wilke and Utley, 1988. From this point of view TSH-RIA's are "first generation" assays.…”

Section: Tsh-assaysmentioning

confidence: 99%

Effects of subclinical hyperthyroidism on bone and heart

Mudde¹

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Section: Tsh-assaysmentioning

confidence: 99%

Effects of subclinical hyperthyroidism on bone and heart

Mudde¹

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Screening for thyroid disease: Authors' reply

Nyström¹,

Lindstedt²,

Eggertsen³

et al. 1989

BMJ

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SIR,-Professor Hugh Tunstall-Pedoe's editorial' on why the French seem to have much less coronary heart disease than the British did not include the theory that associates the condition specifically with a high consumption of milk-that is, not simply with intake of dairy fats.' The evidence that supports this theory2`has to my knowledge never been refuted, or even challenged. The data on food supply published by the Organisation for Economic Cooperation and Development (OECD) for France and the United Kingdom are consistent with this milk theory: French people consume less whole milk but more dairy fat." The table shows the relevant figures for 1985. Consumption of whole milk and dairy fat (grams per. person per day) United France Kingdom Whole milk and fresh whole milk products 230 7 386 6 Butter 254 13 5 Cheese 57 2 17 3 Total dairy fat 42-0 28-8 The OECD figures do not seem to support the polyunsaturated fat theory. The supply per persot of vegetable oils and fats is almost the same in the two countries (32-4 g in France, 33 7 g in the United Kingdom), whereas the supply of fats and oils from marine animals processed for food products is about six times higher in the United Kingdom. Total fats from meat and from fish are 26% and 22% higher, respectively, in France.

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Applications of a New Chemiluminometric Thyrotropin Assay to Subnormal Measurement*

Spencer

LoPresti

Patel

et al. 1990

The Journal of Clinical Endocrinology & Metabolism

335

147

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A new immunochemiluminometric TSH assay (ICMA) was shown to offer improved analytical (+2 SD of zero) and functional (20% interassay coefficient of variation) sensitivity [0.003 vs 0.045 +/- 0.005 (+/- SE; range, 0.01-0.07); 0.018 vs. 0.23 +/- 0.02 (range, 0.10-0.35, mU/L); analytical vs. functional sensitivity limit for the ICMA vs. 10 other TSH immunometric assays, respectively]. The ICMA was used to study the physiological relationship between serum TSH and free T4 [as reflected by free T4 index (FT4I)] values at both steady state and 14 days after acute pharmacological T4 administration (3 mg oral T4 load plus 0.3 mg daily). At steady state, an inverse log/linear relationship was found between serum TSH and FT4I values (log TSH = 2.56 - 0.022 FT4I; r = 0.84; P less than 0.001). Ten to 14 days after acute T4 suppression in 5 euthyroid subjects, serum TSH/FT4I levels had plateaued after decreasing in parallel to the slope of the steady state relationship, suggesting that the degree of T4 suppression of TSH can be predicted from an individual's pituitary TSH/free T4 set-point and the magnitude of the serum T4 elevation achieved. Ambulatory and hospitalized patient sera, previously identified as having low (less than 0.1 mU/L) TSH levels by a less sensitive assay, were restudied by the TSH ICMA. Normal TSH values ranged from 0.39-4.6 mU/L, whereas the majority of hyperthyroid patients [52 of 54 (96% ambulatory) and 22 of 23 (96%, hospitalized)] had undetectable (less than 0.005 mU/L), basal TSH levels and absent TRH stimulated TSH responses. In contrast, most (32 of 37; 86%) of hospitalized nonhyperthyroid patients with low (less than 0.1 mU/L) TSH values due to nonthyroidal illness or glucocorticoid treatment had detectable (greater than 0.01 mU/L) basal and TRH stimulated TSH levels. The positive relationship between basal and TRH-stimulated TSH levels was shown to extend down to the detectability limit of the assay (0.005 mU/L), which further supported the authenticity of the subnormal TSH ICMA measurements. The new TSH ICMA is considered to represent the first of a third generation of clinical TSH assays, since it has a functional (interassay) sensitivity that is 2 orders of magnitude greater than that of typical first generation TSH RIAs and 1 order of magnitude greater than current second generation TSH immunometric methods. Such third generation TSH assays will facilitate both the optimization of T4 therapy as well as the diagnosis of hyperthyroidism in hospitalized patients with nonthyroidal illness.

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The role of precision in determining the performance of a thyrotropin assay in diagnosing hyperthyroidism.

Cited by 5 publications

References 0 publications

Effects of subclinical hyperthyroidism on bone and heart

Effects of subclinical hyperthyroidism on bone and heart

Screening for thyroid disease: Authors' reply

Applications of a New Chemiluminometric Thyrotropin Assay to Subnormal Measurement*

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