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A comparison of methods for assessing thyroid function in nonthyroidal illness.

S Melmed, F L Geola, A W Reed

    The Journal of Clinical Endocrinology and Metabolism
    |February 1, 1982
    PubMed
    Summary
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    Thyroid function tests in sick patients with nonthyroidal illness (NTI) were evaluated. Serum TSH reliably differentiated hypothyroidism from NTI, unlike various free T4 measurements.

    Area of Science:

    • Endocrinology
    • Clinical Chemistry
    • Internal Medicine

    Background:

    • Distinguishing hypothyroidism from nonthyroidal illness (NTI) is crucial in sick patients.
    • Thyroid function tests (TFTs) can be altered in NTI, complicating diagnosis.
    • Accurate differentiation is essential for appropriate patient management.

    Purpose of the Study:

    • To assess the utility of various thyroid function tests in differentiating hypothyroidism from NTI.
    • To compare the diagnostic performance of different free thyroxine (free T4) assays.
    • To identify the most reliable test for distinguishing primary hypothyroidism in the context of NTI.

    Main Methods:

    • Evaluated multiple thyroid function tests including serum T4, free T4 index, free T4 by equilibrium dialysis, calculated free T4, T3, reverse T3 (rT3), and TSH.

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  • Tested assays across various groups: healthy controls, hypothyroid patients, NTI patients (ICU, liver disease, renal failure, oncology), pregnant women, estrogen users, and hyperthyroid patients.
  • Utilized three different radioimmunoassay (RIA) methods for TSH and three commercial kits for free T4.

    • Main Results:

    • All free T4 measurement methods, including free T4 index and dialysis, showed subnormal values in a significant number of NTI patients.
    • Free T4 assays were effective for diagnosing hypothyroidism, hyperthyroidism, and euthyroidism in high thyroxine-binding globulin (TBG) states but not consistently in NTI.
    • Serum TSH demonstrated the highest reliability in differentiating primary hypothyroidism from NTI with low serum T4.

    Conclusions:

    • Standard free T4 measurements are unreliable for diagnosing thyroid status in patients with NTI.
    • Serum TSH is the most effective test for differentiating primary hypothyroidism from NTI.
    • Further research may be needed to refine diagnostic approaches for thyroid dysfunction in critically ill patients.