Interference in a two-site immunoradiometric assay for thyrotropin in a child.
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Biomedical subjects
Publications and source records attributed to C F Cusick.
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The thyroxine:thyroxine-binding globulin ratio in serum (T4:TBG) has been proposed as a measure of thyroid status unaffected by altered binding protein levels. Here 320 apparently euthyroid patients are used to derive euthyroid ranges for serum thyroxine concentrations at specific TBG levels. These ranges are compared with those predicted by a T4:TBG reference range derived from the same patient data. The comparison suggests that the ratio would give false positives for hyperthyroidism at low TBG levels and false negatives at high TBG levels. To overcome this the use of graphical reporting of results or the relation of patient results to empirical reference ranges appropriate to the TBG level is suggested.
Results are presented on two patients with complete and two with partial thyroxine-binding globulin (TBG) deficiency. All four subjects had lowered serum thyroxine but were clinically euthyroid. While thyroid hormone uptake tests or TBG assay were effective in the recognition of such individuals, indices based on these tests were misleading in assessing their thyroid status. Results within the reference range were obtained with the Immophase Free Thyroxine assay.
The use of small sandwich chambers containing silica-gel-impregnated glass fibre sheets allows chromatographic separation of lecithin and sphingomyelin in 3 minutes, compared with 45 minutes on conventional silica gel media. Quantitation by measuring the areas of the phospholipid spots after staining with a molybdate stain or 8-anilino-1-naphthylamino sulphonic acid was found to be accurate and more convenient than densitometry. Although slight inaccuracies may be caused by lack of resolution from certain phospholipids, this was not found to be a problem in amniotic fluid analyses as they are either absent or present only in trace quantities. The speed of the technique makes it particularly useful for clinical purposes.
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