Vergleich von intravenösem TRH-Test und T₄-Schilddrüsensuppressionstest zur Diagnostik der Grenzhyperthyreose

Abstract

In a prospective study of 60 patients with T3 and/or T4 values within +/- 10% of the upper limit of normal, the suppressibility of thyroid storage values before and after oral administration of 3 mg L-thyroxine was tested and compared with the results of an intravenous TRH test. In 46 patients the results of the two methods agreed (77%): in 31 patients (52%) radioiodine uptake could not be suppressed nor TSH stimulated in the TRH test. Physiological suppression of the storage values in normal TSH stimulation after TRH as a sign of completely euthyroid function was present in 15 (25%). In the remaining 14 patients, 13 had a suppressed TRH test. In all patients radioiodine uptake could be suppressed either normally (above 50%) or partially (20-30%). A normal T4 suppression test in the absence of TSH rise after TRH indicates that biologically active TSH is circulating, even though not demonstrated by radioimmuno-assay. A normal T4 suppression test is an important argument against treating a given case of hyperthyroidism. The T4 suppression test reveals smooth gradation between euthyroid and hyperthyroid states. If the TRH test is normal one can assume a physiological T4 suppression test and no further tests are needed. If the TRH test is negative and there is only slight elevation of the thyroid hormones, the T4 suppression test is indicated before definitive treatment of hyperthyroidism is initiated.