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The triiodothyronine suppression test

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      Abstract

      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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      References

        • Werner S.C.
        • Hamilton H.
        • Nemeth M.
        Graves' disease: hyperthyroidism or hyperpituitarism?.
        J. Clin. Endocrinol. 1952; 12: 1561
        • Werner S.C.
        • Hamilton H.
        Pituitary-thyroid relations.
        Lancet. 1953; 1: 796
        • Werner S.C.
        Euthyroid patient with early eye signs of Graves' disease. Their response to l-triiodothyronine and thyrotropin.
        Am. J. Med. 1955; 18: 608
        • Werner S.C.
        • Spooner M.
        A new and simple test for hyperthyroidism employing l-triiodothyronine and the twenty-four hour I131 uptake method.
        Bull. New York Acad. Med. 1955; 31: 137
        • Perlmutter M.
        • Slater S.
        Use of thyroid hormone to differentiate between hyperthyroidism and euthyroidism.
        J.A.M.A. 1955; 158: 718
        • McConahey W.M.
        • Owen Jr., C.A.
        Studies of the inhibitory effect of l-triiodothyronine on thyroidal I131 uptake in euthyroid persons and patients with exophthalmic goiter.
        J. Clin. Endocrinol. 1956; 16: 1480
        • Derome G.
        • Mahaux J.
        • Henry J.A.
        L'épreuve d'inhibition de la captation thyroïdienne d'iode 131 par la l-triiodothyronine chez les hyperthyroïdies et chez les euthyroïdiens.
        Ann. d'Endocrinol. 1957; 18: 1030
        • Dresner S.
        • Schneeberg N.G.
        Rapid radioiodine suppression test using triiodothyronine.
        J. Clin. Endocrinol. 1958; 18: 797
        • Hales I.B.
        • Myhill J.
        • Oddie T.H.
        • Croydon M.
        Quantitative observations with the triiodothyronine suppression test of thyroid function.
        J. Clin. Endocrinol. 1961; 21: 189
        • Vellela Pedras J.A.
        • Penna Franca E.
        • Penna Franca H.
        Our experience with the suppression test in the diagnosis of thyroid dysfunctions (415 tests).
        Nuclear-Medizin. 1963; 3: 263
        • Cope O.
        • Rawson R.W.
        • McArthur J.W.
        The hyperfunctioning single adenoma of the thyroid.
        Surg. Gynec. & Obst. 1947; 84: 415
        • Sheline G.E.
        • McCormack K.
        Solitary hyperfunctioning thyroid nodules.
        J. Clin. Endocrinol. 1960; 20: 1401
        • Newburger R.A.
        • Silver S.
        • Yohalem S.B.
        • Feitelberg S.
        Uptake and blood level of radioactive iodine in hyperthyroidism.
        New England J. Med. 1955; 253: 127
        • Barker S.B.
        • Humphrey M.J.
        • Soley M.H.
        The clinical determination of protein-bound iodine.
        J. Clin. Invest. 1951; 30: 55
        • Grossman A.
        • Grossman G.F.
        Protein-bound iodine by alkaline incineration and a method for producing a stable cerate color.
        J. Clin. Endocrinol. 1955; 15: 354
        • Silver S.
        The thyroid gland and I131.
        in: Radioactive Isotopes in Medicine and Biology (Medicine). 2nd ed. Lea & Febiger, Philadelphia1962: 52
        • Sterling K.
        • Tabachnik M.
        Resin uptake of I131-triiodothyronine as a test of thyroid function.
        J. Clin. Endocrinol. 1961; 21: 456
        • Burke G.
        • Metzger B.E.
        • Goldstein M.S.
        Routine clinical application of an electrophoretic method for characterizing thyroid function.
        J. Lab. & Clin. Med. 1964; 63: 708
        • McKenzie J.M.
        Studies on the thyroid activator of hyperthyroidism.
        J. Clin. Endocrinol. 1961; 21: 635
        • Molnar G.D.
        • Wilber R.O.
        • Lee R.E.
        • Woolner L.B.
        • Keating Jr., F.R.
        On the hyperfunctioning solitary thyroid nodule.
        in: 3rd ed. Proc. Staff Meet. Mayo Clin.40. 1965: 665
        • McKenzie J.M.
        Review: pathogenesis of Graves' disease: role of the long-acting thyroid stimulator.
        J. Clin. Endocrinol. 1965; 25: 301
        • Skanse B.N.
        • Riggs D.S.
        Thyrotoxicosis factitia (alimentary thyrotoxicosis). Its differentiation from spontaneous thyrotoxicosis with the aid of radioactive iodine.
        J. Clin. Endocrinol. 1948; 8: 532
        • Greer M.A.
        The effect on endogenous thyroid activity of feeding desiccated thyroid to normal human subjects.
        New England J. Med. 1951; 244: 385
        • Greer M.A.
        • Smith G.E.
        Method of increasing the accuracy of the radioiodine uptake as a test for thyroid function by the use of dessicated thyroid.
        J. Clin. Endocrinol. 1954; 14: 1374
        • Oddie T.H.
        • Rundle F.F.
        • Thomas I.D.
        • Hales I.
        • Catt B.
        Quantitative observations with the thyroxine suppression test of thyroid function.
        J. Clin. Endocrinol. 1960; 20: 1146
        • Sisson J.C.
        Principles of, and pitfalls in, thyroid function tests.
        J. Nuclear Med. 1965; 6: 853
        • Bakke J.L.
        • Kammer H.
        • Lawrence N.
        Effect of thyroid hormone on human pituitary thyroid-stimulating hormone content.
        J. Clin. Endocrinol. 1964; 24: 281
        • Guinet P.
        • Descour C.
        Étude critique du test de Werner.
        Rev. Lyon Méd. 1962; 11: 501
        • Werner S.C.
        Diagnostic uses of thyroid and triiodothyronine.
        in: Werner S.C. The Thyroid. Hoeber Medical Division, Harper & Row, New York1962: 223
        • Werner S.C.
        Response to triiodothyronine as an index of persistence of disease in the thyroid remnant of patients in remission from hyperthyroidism.
        J. Clin. Invest. 1956; 35: 57
        • Hales L.B.
        • Myhill J.
        • Oddie T.H.
        • Rundle F.F.
        Thyroid suppressibility after therapy for thyrotoxicosis.
        J. Clin. Endocrinol. 1961; 21: 569
        • Cassidy C.E.
        • Vanderlaan W.P.
        Thyroid-suppression test in the prognosis of hyperthyroidism treated by anti-thyroid drugs.
        New England J. Med. 1960; 262: 1228
        • Cassidy C.E.
        Use of a thyroid suppression test as a guide to prognosis of hyperthyroidism treated with antithyroid drugs.
        J. Clin. Endocrinol. 1965; 25: 155
        • Østergård Kristensen H.P.
        • Dyrbye M.
        • Korsgård Christensen L.
        Trijodtyroninsup-pressionstestens diagnostiske vaerdi ved hypertyreose.
        Ugeskr. Laeg. 1963; 125: 10
        • Friis T.
        The triiodothyronine suppression test in hyperthyroid patients on antithyroid medication.
        in: Current Topics in Thyroid Research. Academic Press, Inc, New York1965: 719
        • Burke G.
        The radiothyroxine turnover study in the diagnosis of thyroid disease.
        Ann. Int. Med. 1966; 64: 1208
        • Kriss J.P.
        • Pleshakov V.
        • Chien J.R.
        Isolation and identification of the long-acting thyroid stimulator and its relation to hyperthyroidism and circumscribed pretibial myxedema.
        J. Clin. Endocrinol. 1964; 24: 1005
      1. Silverstein, G. E., Cogan, S. R. and Burke, G., The natural history of the autonomous hyperfunctioning thyroid nodule. (In preparation.)