The triiodothyronine suppression test

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      The results of the triiodothyronine suppression test, as performed in one hundred fifty-five patients with suspect thyroid dysfunction, are recorded. The clinical utility of this procedure as an adjunct to the laboratory diagnosis of hyperthyroidism is confirmed. The results of the present study support the validity of the criteria for normal (thyroidal) suppressibility originally set forth by Werner and Spooner. A clearly abnormal response to triiodothyronine was noted in six of twenty-one patients with nontoxic nodular goiter; this finding suggests that the usual criteria for normal suppressibility do not obtain in this group. The diagnostic and/or prognostic value of the triiodothyronine suppression test in the treated hyperthyroid patient remains the subject of conflicting opinion. The small number of patients in this category included in the present report precludes a definitive statement, but only a limited correlation between the response to triiodothyronine and recurrence of clinical hyperthyroidism was observed. Long-term clinical assessment of euthyroid patients with exophthalmos in this series indicates that a normal response to triiodothyronine militates against the ultimate development of clinical thyrotoxicosis. The recent demonstration of long-acting thyroid stimulator activity in the serum of a euthyroid exophthalmic patient unresponsive to triiodothyronine raises a number of theoretical considerations and underscores the significance of abnormal suppressibility in such cases. The importance of post-triiodothyronine I131 uptake studies in the assessment of thyroid-stimulating hormone (TSH)-(in)dependence of hyperfunctioning thyroid nodules has been noted; the necessity for both quantitative and topographic I131 uptake studies in these cases is emphasized.
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