Monitoring treatment of congenital hypothyroidism by highly sensitive immunoradiometric assay for thyroid stimulating hormone.

To assess the clinical value of a sensitive immunoradiometric assay for TSH (IRMA-TSH), serum IRMA-TSH levels were compared with those of a radioimmunoassay (RIA-TSH) in twenty-eight patients with congenital hypothyroidism. Among 144 samples taken from them, 44 samples showed undetectable RIA-TSH, while only 10 samples were undetectable by IRMA-TSH. In two patients prospectively followed, RIA-TSH levels were undetectable when serum T3 and T4 were normal. IRMA-TSH levels, however, were detectable when serum T4 levels were elevated or normal. The basal RIA- and IRMA-TSH levels in 4 groups (22 patients) were compared and classified according to the TSH response to TRH. The RIA-TSH levels were undetectable in any in group 1 (n = 7; absent response) or group 2 (n = 5; low response). At the same time, IRMA-TSH levels were undetectable in only three patients in group 1. In group 3 (n = 16; normal response), RIA-TSH levels were undetectable in three, whereas IRMA-TSH levels were detectable in all. The IRMA- and RIA-TSH levels rose in all in group 4 (n = 15; exaggerated response). These results suggest that the serum basal IRMA-TSH levels indicate the responsiveness of TSH to TRH more accurately than basal serum RIA-TSH levels. Therefore, it was concluded that IRMA-TSH may obviate the need for a TRH test and simplify the evaluation of adequate dosage in patients with congenital hypothyroidism during thyroxine treatment.