Evaluation of a sensitive chemiluminescent assay for TSH in the follow-up of treated thyrotoxicosis.

We have studied 21 patients treated for thyrotoxicosis to evaluate a highly sensitive chemiluminescent thyrotrophin (TSH) assay in the assessment of changing thyroid status. Serum TSH was generally suppressed with high serum thyroid hormone concentrations and invariably rose when free T4 and T3 fell substantially below the normal range. However TSH values in 14 of the 21 patients remained undetectable or subnormal for variable periods despite normal or even slightly subnormal free T4 and T3 values. The level of free T4 and T3 at which TSH concentrations rose was highly variable, suggesting differing degrees of hypothalamo-pituitary suppression. Sensitive TSH assays are likely to provide useful information regarding physiological regulation of TSH secretion in man, but our data indicate that in certain circumstances these assays used alone will be inadequate for biochemical assessment of thyroid status.