Assessment of thyroxine suppression in thyroid carcinoma patients with a sensitive immunoradiometric TSH assay

Serum TSH was determined with a sensitive radioimmunometric method (TSH IRMA) in 57 patients on suppression therapy with T4 after operation for differentiated thyroid carcinoma. When using a conventional RIA technique basal TSH was not detectable and remained so even after stimulation with TRH. With the TSH IRMA method 46 patients had a basal TSH below the detection limit (0.02 mU/l) (81%) and in seven patients the values were between 0.02 and 0.05 mU/l (12%). In 23 of these patients there was a small increment of 0.01-0.15 mU/l. In two patients the basal TSH was 0.08 and 0.09 mU/l, and the increment after TRH was less than 0.7 mU/l. In two other patients with basal values close to 0.2 mU/l the increment after TRH was more than 1.0 mU/l. An undetectable basal TSH value did not thus predict an absent response to TRH. The responses were, however, in all but two cases, so small that they could be regarded as clinically insignificant. Therefore, the authors conclude that a basal TSH of 0.1 mU/l, as measured with a TSH IRMA method with a detection limit of 0.05, is a sufficient indication of TSH suppression in carcinoma patients on T4 therapy and that further testing with the TRH-stimulation test is unnecessary.