Predictive values of thyroxine, thyrotropin, and triiodothyronine concentrations in serum

The predictive values of total thyroxine, thyrotropin, and total triiodothyronine concentrations in serum for clinically apparent and subclinical hypothyroidism and hyperthyroidism were determined by retrospective analysis of clinical cases chosen from the frequency distributions of hormone test results. Very low total thyroxine concentrations, less than 25 microgram/L, were specific for hypothyroidism. Most subclinical hypothyroid cases had intermediate or low total thyroxine concentrations, 35-60 microgram/L, with moderately increased thyrotropin concentrations, greater than 12 milli-int. units/L. Thyrotropin cut-off concentrations were identified that had predictive values greater than 90% for classifying untreated and hormone-treated hypothyroid cases. Above-normal total thyroxine concentrations, regardless of absolute value, were not specific for hyperthyroidism, because binding-protein alterations related to estrogen taking were prevalent and produced occasional marked increases in serum total thyroxine. Nevertheless, cut-off concentrations for serum total thyroxine and total triiodothyronine were identified that had a predictive value greater than 90% for hyperthyroidism, without necessitating measurement of the capacities or concentrations of hormone-binding proteins.