On the albumin-dependence of measurements of free thyroxin. II. Patients with non-thyroidal illness.

We studied the relation between thyroxin-binding proteins and free thyroxin (FT4) measurements by five radioimmunoassays (RIA) and an FT4 index (FT4I) in patients with non-thyroidal illness (NTI). The one-step FT4 RIAs and the FT4I frequently failed to identify the true FT4 status (as determined by equilibrium dialysis) of NTI patients. In these patients, falsely low FT4 results with one-step RIAs and FT4I were associated with decreasing total T3 and T4 concentrations, which, furthermore, paralleled decreasing serum albumin concentrations. All NTI patients with "low T3, low T4 syndrome" had subnormal albumin concentration. The two-step RIAs and equilibrium dialysis showed normal FT4 concentrations in most patients with NTI. However, sera from a subset of NTI patients with "low T3 syndrome" gave above-normal FT4 results with these methods. From their predictably poor performance in the presence of a subnormal albumin concentration, we conclude that the one-step FT4 RIAs and FT4I are inappropriate for testing the thyrometabolic status of NTI patients.