This study provides further information on the prevalence of thyroid dysfunction and autoimmune thyroid diseases in an iodine sufficient area. In addition, it suggests that more than half of the patients with unsuspected hypothyroidism were negative for autoantibodies and that the excessive iodine intake may be involved in causing latent hypothyroidism.

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We measured the free thyroxin (FT4) concentration in serum from 79 patients with nonthyroidal illnesses (NTI), using two analog RIAs and two calculation methods, and compared the results with those by ultrafiltration (UF) as a reference. The percentage of NTI patients with subnormal concentrations of FT4 was 10.1% by UF; 20.3% by mathematical calculation (MC) according to mass-action theory; 19.0% by FT4 index (FT4I), calculated by the triiodothyronine-albumin uptake method expressed as the bound:free ratio; 37.2% by Amerlex M FT4 (P less than 0.001 vs UF, P less than 0.025 vs MC); and 33.3% by Coat-A-Count FT4 with albumin blocker (P less than 0.001 vs UF, P less than 0.025 vs MC). No significant correlations were found between FT4 (UF) and T4-binding proteins (TBP) in serum, but FT4 (MC) correlated with T4-binding globulin (TBG) (r = 0.383, P less than 0.001), FT4I with TBG (r = 0.345, P less than 0.001), FT4 (Amerlex M) with albumin (r = 0.491, P less than 0.001), and FT4 (Coat-A-Count) with TBG (r = 0.636, P less than 0.001). All FT4 measurements correlated well with each other, but correlations were stronger between both calculated FT4 values and FT4 (UF), r = 0.702 to 0.760, than between both values for RIA and FT4 (UF), r = 0.475 to 0.665. These results indicate that in comparison with the UF method, both calculated FT4 values are little affected by TBP concentrations, and FT4 (MC) or FT4I by T3-albumin uptake may be more appropriate than analog RIA for evaluation of circulating FT4 concentration in NTI.

An ultrafiltration method (UF) for measuring free thyroxine (FT4) and free triiodothyronine (FT3) using the Diaflow YM membrane (Centricon-10) is described. The results are compared with those by equilibrium dialysis (ED) and also by mathematical calculations derived from T4, T3, and binding protein concentrations. The precision with the UF method was excellent. The normal ranges of FT4 and FT3 by the three methods are all comparable. There was a high degree of correlation of FT4 or FT3 results by UF with those by ED and by calculation (r = 0.940-0.974, n = 161, P less than 0.001). FT4 and FT3 by all methods agreed well for hyperthyroidism, hypothyroidism, and for patients with low T4-binding globulin. The mean FT3 in pregnancy was lower than the normal value for all methods, and FT4 concentrations by UF and calculation also decreased in late pregnancy. The mean FT4 by UF and ED in low T3 syndrome were significantly higher than in the normal controls, while the calculated FT4 was lower. The FT3 in low T3 syndrome distributed normal to subnormal in all methods. These results indicate that a) the UF method is a reliable reference method for measuring FT4 and FT3 concentrations; b) the UF results agree well with those by ED and also with theoretically derived values in subjects with thyroid diseases and TBG abnormalities; c) for patients with low T3 syndrome, the FT4 results obtained by UF and ED are similarly discrepant from the calculated results, implying the existence of binding inhibitor(s) which affect both UF and ED measurements.