A Rapid (48 hours) Thyroid Suppression Test using a Single Oral Dose of 100 of Triiodothyronine

Denis G. Ikkos; Elli Lakka - Papadodima; Constantin Ntalles

doi:10.1055/s-0038-1624823

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1973; 12(03): 218-224
DOI: 10.1055/s-0038-1624823

Originalarbeiten — Original Articles — Travaux Originaux

Schattauer GmbH

A Rapid (48 hours) Thyroid Suppression Test using a Single Oral Dose of 100 of Triiodothyronine

Un test rapide (48 heures) de suppression thyroïdienne par application oral d’une dose unique de 100 μg de triiodothyronineEin schneller (48 Stunden) Schilddrüsen-Unterdrückungstest nach oraler Gabe einer Einzeldosis von 100 μg Trijodthyronin

Authors

Denis G. Ikkos

¹From the Department of Endocrinology and Radioisotopes Laboratory, Evangelismos Hospital, Athens
Elli Lakka - Papadodima

¹From the Department of Endocrinology and Radioisotopes Laboratory, Evangelismos Hospital, Athens
Constantin Ntalles^*

¹From the Department of Endocrinology and Radioisotopes Laboratory, Evangelismos Hospital, Athens

Abstract

Des mesurages répétés de la fixation thyroïdienne de 10 minutes du ¹³²I injecté intraveineusement on été effectués sur 55 malades euthyroïdiens sans et avec goitre et sur 16 malades hyperthyreoïdiens par 4 jours consécutifs. Immédiatement après le premier mesurage tous les malades recevaient une dose unique oral de 100 μg de Triiodothyronine (T₃). Les valeurs de fixation 24, 48 et 72 heures après le T₃ (moyen ± déviation standard) étaient de 75 ± 1,7, 64 ± 1,8, et 67 ± 1,9 dans le groupe euthyroïdien et le 106 ± 2,6, 104 ± 2,2 et 108 ± 4,0 dans le groupe hyperthyroïdien, exprimés en pourcentage du groupe controle. 48 heures après T₃ tous les personnes euthyroïdiens, sauf une, avaient des valeurs en dessous de 88% tandis que la valeur la plus basse des personnes hyperthyroïdiens ce jour était de 93%. La séparation des valeurs 48 heures des deux groupes était complète après avoir respecté l’influence de la première fixation sur la valeur 48 heures. On peut donc supposer q’un test thyroïdien de suppression utilisable en clinique peut-être effectué en 48 heures après une administration oral de 100 μg de T₃ et mesurage de la fixation 10 minutes après l’injection du radioisotope.

Summary

Repeat measurements of the 10-min ¹³²I thyroid uptake after i.v. administration of the isotope were performed daily for at least four consecutive days in 55 euthyroid goitrous or non-goitrous subjects and 16 hyperthyroid patients. Immediately after the first measurement all subjects were given a single oral dose of 100 µg of triiodothyronine (T₃). The uptake values 24, 48 and 72 hours after T₃ were (mean ± S.E.) for the euthyroid group 75 ± 1.7, 64 ± 1.8 and 67 ± 1.9 and for the hyperthyroid group 106 ± 2.6, 104 ± 2.2 and 108 ± 4.0 respectively, when the results were expressed in percent of the control values.

Forty-eight hours after T₃ all euthyroid subjects - except one - had values lower than 88%, while the lowest value in the hyperthyroid subjects on that day was 93%. The separation of the 48 hours values of the two groups became complete when the effect of the initial uptake on the 48 hours value was taken into account. It is suggested, therefore, that a clinically useful T₃ thyroid suppression test can be performed within 48 hours using a single oral dose of 100 fxg of T₃ and the 10-min uptake after i.v. administration of the radioisotope.

Wiederholte Messungen der 10-min ¹³²J-Speicherung der Schilddrüse nach intravenöser Verabreichung des Isotopes wurden täglich durch mindestens vier aufeinanderfolgende Tage bei 55 euthyreoten Personen, mit und ohne Kropf, und bei 16 hyperthyreoten Patienten durchgeführt. Unmittelbar nach der ersten Messung wurde allen Personen eine Einzeldosis von 100 μg Trijodthyronin (T₃) oral verabreicht. Die Speicherwerte 24, 48 und 72 Stunden nach T₃ betrugen (Durchschnitt ± Standardfehler) bei der euthyreoten Gruppe 75 ± 1,7, 64 ± 1,8 bzw. 67 ± 1,9 und bei der hyperthyreoten Gruppe 106 ± 2,6, 104 ± 2,2 bzw. 108 ± 4,0, wenn die Resultate als Prozentsatz der Kontrollwerte ausgedrückt wurden. 48 Stunden nach T₃zeigten alle euthyreoten Personen, außer einer, Werte unter 88%, während der niedrigste Wert bei den hyperthyreoten Personen an diesem Tag 93% betrug. Die Trennung der 48-Stundenwerte der beiden Gruppen wurde vollständig, nachdem der Effekt der ersten Speicherung auf den 48-Stundenwert berücksichtigt wurde. Es ist daher anzunehmen, daß ein klinisch verwendbarer T₃Schilddrüsen-Unterdrückungstest innerhalb 48 Stunden nach oraler Gabe von 100 (ig T₃und mittels Bestimmung der 10-min Speicherung nach intravenöser Verabreichung des Radio-Isotöpes durchgeführt werden kann.

Full Text

References

References
1 Alexander W. D, McG RHarden, Shimmins J. Thyroidal suppression by triiodothyronine as a guide to the duration of treatment of thyrotoxicosis with antithyroid drugs. Lancet II 1041 1966;
2 Alexander W. D, McG RHarden, Larty D, Shimmins J. Thyroidal suppressibility after stopping long term treatment of thyrotoxicosis with antithyroid drugs. Metabolism 1969; 18: 58.
3 Auger P, Saucier G, Drouin R, Paquet C, Brunet J. Test de suppression thyroidienne. Canad. med. Ass. J. 1965; 93: 962.
4 Bakke J. L, Kammer H, Lawrence N. Effect of thyroid hormone on human pituitary thyroid-stimulating hormone. J. Clin. Endocr. 1964; 24: 281.
5 Bonnier G, Tedin O. Biologisk Variationsanalyse, Svenska Bokförlaget. Stockholm 1940
6 Cassidy C.E. Use of a thyroid suppression test as a guide to prognosis of hyperthyroidism treated with antithyroid drugs. J. Clin. Endocr. 1965; 25: 155.
7 Cassidy C. E, Wanderlaan W. P. Thyroid supppression test in the prognosis of hyperthyroidism treated by antithyroid drugs. New Engl. J. Med. 1960; 262: 1228.
8 Charkes N. D, Cantor R. E, Goluloff B. A three day, double isotope, 1-triiodothyronine suppression test of thyroid autonomy. J. Nucl. Med. 1967; 8: 627.
9 Derome JCh, Mahaux Henry J. A. L'epreuve d'inhibition de la captation thyroidienne d'I-131 par la triiodothyronine chez les hyperthyroidiens et chez les euthyroidiens. Ann. Endocr. 1957; 18: 1030.
10 Dresner S, Schneeberg N. G. Rapid radioiodine suppression test using triiodothyronine. J. Clin. Endocr. 1958; 18: 797.
11 Friis T. On the effect of 1-triiodothyronine on the thyroid gland and its clinical application (the triiodothyronine suppression test). Acta med. Scand 1963; 173: 569.
12 Greer M. A, Smith G. E. Method for increasing the accuracy of the radioiodine uptake as a test for thyroid function by the use of desiccated thyroid. J. Clin. Endocr. 1954; 14: 1374.
13 Guinet P, Decour C. Le test de Werner. Experience personelle. Gaz. med. Franç. 1963; 70: 421.
14 Hales I. B, Myhill J, Oddie T. H, and Croydon M. Quantitative observations with the triiodothyronine suppression test of thyroid function. J. Clin. Endocr. 1961; 21: 189.
15 Hales I. B, Myhill J, Oddie T. H, F. F R. und le Thyroid suppressibility after therapy for thyrotoxicosis. J. Clin. Endocr. 1961; 21: 569.
16 Hales I, Stiel J, Reeve T, Heap T, Myhill J. Prediction of the long term results of antithyroid drug therapy for thyrotoxicosis. J. Clin. Endocr. 1969; 29: 998.
17 Hamolsky M. W, Stein M, Freedberg A. S. The thyroid hormone-plasma protein complex in man. II A new in vitro method for study of "uptake" of labelled hormonal components by human erythrocytes. J. Clin. Endocr. 1957; 17: 33.
18 Hobbs J. R, Bayliss R. I. S, Maclagan N. F. The routine use of 132I in the diagnosis of thyroid diseases. Lancet I: 8 1963
19 Ikkos D. G, Lakka-Papadodima E, Ntalles K. A new test of the reserve capacity of the pituitary to secrete thyrotropic hormone (TSH-reserve test). J. Clin. Endocr. 1970; 31: 98.
20 Ingbar S. H, Webber K. A. The thyroid gland. In Williams R. H. (ed). Textbook of Endocrinology. W. B. Saunders Company; Philadelphia and London: 1968. p. 171
21 Knopp C. T, Rennie M. H, Frenkel E. P, Korst D. R. The clinical application of thyroid stimulation and suppression tests. Amer. J. Med. Sei. 1962; 244: 316.
22 Kristensen H. P. O, Dyrbye M, Cristensen L. K. The triiodothyronine suppression test. Acta med. Scand. 1963; 173: 411.
23 Lawson J. D. The free Achilles reflex in hypothyroidism and hyperthyroidism. New Engl. J. Med. 1958; 259: 761.
24 Leistner J. H, Wersel C, Gronau U. Thyroid suppression test by means of Ts. Klin. Wschr. 1967; 45: 1241.
25 McCohaney W. M, Owen Jr. C. A. Studies on the inhibitory effect of l-tiiodothyronine on thyroidal I¹³¹ uptake in euthyroid persons and patients with exophthalmic goiter. J. Clin. Endocr. 1956; 16: 1480.
26 Mitchell M. L. Resin uptake of radiothyroxine in sera from nonpregnant and pregnant women. J. Clin. Endocr. 1958; 18: 1437.
27 Morgans M. E, Oldham A. K, Trotter W. R. The effect of exogenous thyroxine on radioiodine uptake in normal subjects and in cases of thyrotoxicosis in remission. J. Endocr. 1952; 8: 250.
28 Murphy B. P. The determination of thyroxine by competitive protein-binding analysis employing an anion-exchange resin and radiothyroxine. J. Lab. Clin. Med. 1965; 66: 161.
29 Murphy B. P, Pallee C. J. Determination of thyroxine utilizing the property of protein binding. J. Clin. Endocr. 1964; 24: 187.
30 Odell W. D, Wilber J. F, Utiger R. D. Studies on thyrotrophic hormone. Ree. Progr. Horm. Res. 1967; 23: 60.
31 Oddie T. H, F. F R, und le Thomas I. D, Hales I. B, Call B. Quantitative observations with the thyroxine suppression test of thyroid function. J. Clin. Endocr. 1960; 20: 1146.
32 Perlmutter M, Slater S. Use of thyroid hormone to differentiate between hyperthyroidism and euthyroidism. J. Amer. Med. Ass. 1955; 158: 718.
33 Singelakis P, Ikkos D. G, Gonticas S. C. A 6-days study of the effect of 100 Mg triiodothyronine (T₃)/day on the early thyroid uptake of radioiodine in euthyroid and thyrotoxic subjects. Program of the 3rd Annual Meeting of the European Thyroid Association Athens 1969; p. 25.
34 Snedecor G. W. Statistical method applied to experiments in agriculture and biologyIowa State University Press, Ames, Iowa. 1964
35 Spencer R.P, Henkelman C. R, King E. R. Thyroid parameters during triiodothyronine administration. Metabolism. 1958; 7: 119.
36 Starr P, Liebhold-Schueck R. Effect of oral thyroxine and triiodothyronine on radioactive iodine uptake and serum protein-bound-iodine in normal subjects. Proc. Soc. Exper. Biol. Med. 1953; 83: 52.
37 Sterling K, Lashof J. C, Man E. B. Disappearance from serum of I-131 labelled l-thyroxine and l-triiodothyronine in euthyroid subjects. J. Clin. Invest. 1954; 33: 1031.
38 VanderLaan W. P, Cassidy C. The thyroid suppression test in the prognosis of hyperthyroidism treated with antithyroid drugs. J. Clin. Invest. 1959; 38: 1051.
39 Villela Pedras J. A, Penna Franca E, Penna Franca H. Our experience with the suppression test in the diagnosis of thyroid dysfunction (415 tests). Nucl. Med. 1963; 3: 263.
40 Werner S. C, Hamilton H, Nemeth M. Graves' disease: Hyperthyroidism or hyperpituitarism? J. Clin. Endocr. 1962; 12: 1561.
41 Werner S. C, Spooner M. A new and simple test for hyperthyroidism employing l-triiodothyronine and the twenty-four hour I¹³¹ uptake method. Bull. N. Y. Acad. Sei. 1955; 31: 137.