Clinical evaluation of a thyroxine-binding globulin assay in calculating a free-thyroxine index.
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Biomedical subjects
Publications and source records attributed to S S Stoffer.
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The tablet thyroxine content of a brand name and two generic products were studied. The mean thyroxine content was significantly different in the generic tablets when compared with that in the brand name product. The coefficient of variation of tablet thyroxine was lowest in the brand name, although this product had only 78% of expected potency. When these products were tested in three hypothyroid patients, two serum free thyroxine indexes were well outside the normal range when the most potent generic product was substituted for the brand name drug. Manufacturers should be required to measure the thyroxine content of their tablets. Until such time that levothyroxine products become more uniform, physicians, pharmacists, and legislators should not encourage product switching.
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It has been reported that patients taking the anticonvulsant drugs phenytoin and/or phenobarbital may experience osteomalacia. In a phenytoin-treated patient with osteomalacia, switching the drug regimen to phenobarbital led to prompt resolution of her symptoms and restoration of normal serum calcium and serum 25-hydroxyvitamin D values. It seems prudent, when feasible, to switch patients from phenytoin to phenobarbital when their anticonvulsive management is complicated by the onset of osteomalacia. Such simple manipulation of anticonvulsive drug therapy may obviate the need for vitamin D and calcium administration.
The free thyroxine (FT4) test of Clinical Assays, Corning Medical, and Damon Diagnostics were evaluated in 245 patients. Although all three assays generally correlated well with the clinical functional status, there were apparent discrepancies in the clinically euthyroid population. All patients with discordant values had either relatively high or low triiodothyronine (T3) uptakes. In these instances, the free-thyroxine index gave a more accurate assessment of the clinical thyroid status than did the FT4. In our opinion, these findings place a critical limitation on these assays as a replacement for the free-thyroxine index.
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