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Exp Clin Endocrinol Diabetes 2002; 110(7): 355-360
DOI: 10.1055/s-2002-34993
Article

© Johann Ambrosius Barth

Surveillance of TSH-Suppressive Levothyroxine Treatment in Thyroid Cancer Patients: TRH Testing Versus Basal TSH Determination by a Third Generation Assay

R. Görges1 , B. Saller2 , E. G. Eising1 , B. Quadbeck2 , K. Mann2 , A. Bockisch1
  • 1 Department of Nuclear Medicine, University Hospital Essen, Germany
  • 2 Department of Endocrinology, University Hospital Essen, Germany
Further Information

Publication History

received 11 February 02 first decision 12 March 02

accepted 6 May 02

Publication Date:
24 October 2002 (online)

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Summary

Objective, design and methods: Although TRH testing has been eliminated in the diagnosis of most benign thyroid diseases, it is still controversial whether or not it can be replaced by ultrasensitive determination of basal TSH for monitoring optimal TSH suppression in thyroid cancer patients. We compared basal and TRH-stimulated TSH values measured by a 2nd generation assay (lower detection limit 0.1 mU/l) and by a 3rd generation assay (lower detection limit 0.005 mU/l) in 209 thyroidectomized thyroid cancer patients under suppressive levothyroxine treatment. Results: In the 2nd generation assay all patients had basal TSH values < 0.1 mU/l (criterion of admission in the study), and the TRH-stimulated TSH values were above the lower detection limit in 47% of the patients (range < 0.1-1.0 mU/l). In the 3rd generation assay TSH was above the lower detection limit in 67% under basal conditions (range < 0.005-0.098 mU/l), and in 83% after TRH stimulation (range < 0.005-1.000 mU/l). We observed close correlations (p < 0.001) between basal and TRH-stimulated TSH in the 3rd generation assay (r = 0.86), between TRH-stimulated TSH in the 2nd and 3rd generation assay (r = 0.95), and between TRH-stimulated TSH in the 2nd generation assay and basal TSH in the 3rd generation assay (r = 0.73). The ratio between TRH-stimulated and basal TSH values was in the average range 7-9 : 1. Subdividing the patients in three subgroups based on the TRH-stimulated TSH values from the 2nd generation assay, the corresponding basal TSH values (median and [25.-75. percentile]) from the 3rd generation assay were < 0.005 [< 0.005-0.010] mU/l in subgroup A (2nd generation stim. TSH: < 0.15 mU/l), 0.032 [0.021-0.040] mU/l in subgroup B (2nd generation stim. TSH: 0.15-0.4 mU/l), and 0.066 [0.046-0.085] mU/l in subgroup C (2nd generation stim. TSH: ≥ 0.5 mU/l). Conclusions: Even in those thyroid cancer patients where a high degree of TSH suppression is the therapeutic goal, 3rd generation TSH assays enable a reliable adjustment of the levothyroxine dose by basal TSH determinations. In laboratories still using 2nd generation assays, the monitoring of maximal TSH suppression in patients with high-risk thyroid cancer should be performed by TRH testing.

Key words:

Thyroid cancer - TSH suppression - TRH testing - ultrasensitive TSH - third generation assay

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M.D. Rainer Görges

Department of Nuclear Medicine

University Hospital Essen

Hufelandstr. 55

45122 Essen

Germany

Phone: ++ 49-201-7232032

Fax: ++ 49-201-7235964

Email: rainer.goerges@uni-essen.de