Slow thyroxine binding globulin in the pathogenesis of increased dialysable fraction of thyroxine in nonthyroidal...

The expected decreases of serum total T4, total T3, T4 binding prealbumin, and T4 binding globulin (TBG) concentrations were found in a selected series of patients with nonthyroidal illnesses (NTI). An increase in percent dialysable fraction of T4 was also found. Although serum TBG concentrations were decreased, the proportion of a slow moving form of TBG, designated slow TBG (STBG) was increased, the absolute concentration being not significantly different from that measured in controls. Thus the observed decrease in TBG in NTI occurs in the normal TBG fraction which binds T4 much more avidly than does STBG. It is suggested that the increase in the proportion of STBG, due to a decrease in normal TBG, has an important role in the pathogenesis of the increase in percent dialysable fraction of T4 in serum from patients with NTI.