Improved dialysis method for free thyroxin in serum compared with five commercial radioimmunoassays in nonthyroidal illness and subjects with abnormal concentrations of thyroxin-binding globulin.

We describe a method for free thyroxin (FT4) in serum, based on radioimmunoassay of T4 in serum dialysate, FT4(D). The method is analytically accurate, sensitive, reproducible, and suitable for routine use in the clinical laboratory. We compared results by this method with those obtained with five commercial FT4 assays (Amerlex, GammaCoat, ImmoPhase, LiquiSol, Spiria) and the free T4 index (FT4I). In several of the patients with nonthyroidal illness FT4(D) was above normal and FT4 as measured with the commercial assays was subnormal. In the third trimester of pregnancy all the FT4 methods gave decreased mean values, though the decreases were of various magnitudes: FT4(D) 32%, Amerlex 44%, GammaCoat 40%, Spiria 19%, LiquiSol 16%, and ImmoPhase 13%, respectively. FT4I was significantly higher than normal during late pregnancy. In women taking oral contraceptives the mean FT4I was increased, but there was no significant effect on the results obtained with the various FT4 methods. All subjects with hereditarily high or low serum thyroxin-binding globulin had normal FT4(D) and abnormal FT4I. Amerlex, ImmoPhase, and LiquiSol misclassified some of the subjects with hereditarily abnormal thyroxin-binding globulin.