Serum free thyroxine concentrations in subjects with high circulating levels of thyroxine-binding globulin

Serum free thyroxine (FT4) and thyroid hormone-binding protein concentrations were measured in pregnant women, stilboestrol-treated patients, and subjects with congenital thyroxine-binding-globulin (TBG) excess. In pregnant and stilboestrol-treated patients matched for TBG concentrations, serum FT4 concentrations measured by the Amerlex technique and by calculation, were reduced, as also was the total thyroxine (TT4)/TBG ratio. In congenital TBG excess Amerlex and calculated FT4 concentrations were normal whereas the TT4/TBG ratio was low. In contrast to the Amerlex method, FT4 concentrations by the Immophase procedure were normal in pregnant and stilboestrol-treated individuals and high in congenital TBG excess. We conclude that (i) reduced FT4 concentrations in pregnancy are related to an oestrogen effect rather than to some other pregnancy-associated factor, (ii) the TT4/TBG ratio gives a misleading indication of FT4 concentration in congenital TBG excess, and (iii) that when TBG concentrations are raised Immophase gives higher FT4 values than Amerlex or calculation when each is compared to FT4 values in their normal respective control group.