TRH Stimulation Test

TRH stimulation test
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Purpose assessing the degree of suppression in suspected
hyperthyroidism or hypothyroidism
Prior to the availability of sensitive TSH assays, thyrotropin releasing

hormone or TRH stimulation tests were relied upon for confirming and
assessing the degree of suppression in suspected hyperthyroidism. Typically,
this stimulation test involves determining basal TSH levels and levels 15 to 30
minutes after an intravenous bolus of TRH. Normally, TSH would rise into the
concentration range measurable with less sensitive TSH assays. Third
generation TSH assays do not have this limitation and thus TRH stimulation is
generally not required when third generation TSH assays are used to assess
degree of suppression.
Contents
 1Differential diagnosis use

 2Process and interpretation
 3Side effects and risks
 4See also
 5References
Differential diagnosis use[edit]

TRH-stimulation testing however continues to be useful for the differential
diagnosis of secondary (pituitary disorder) and tertiary (hypothalamic disorder)
hypothyroidism. Patients with these conditions appear to have physiologically
inactive TSH in their circulation that is recognized by TSH assays to a degree
such that they may yield misleading, "euthyroid" TSH results.Use and
Interpretation:[citation needed]
• Helpful in diagnosis in patients with confusing TFTs. In primary hyperthyroidism
TSH are low and TRH administration induces little or no change in TSH levels
• In hypothyroidism due to end organ failure, administration of TRH produces a
prompt increase in TSH
• In hypothyroidism due to pituitary disease (secondary
hypothyroidism)administration of TRH does not produce an increase in TSH
• In hypothyroidism due to hypothalamic disease (tertiary hypothyroidism),
administration of TRH produces a delayed (60–120 minutes, rather than 15–30
minutes) increase in TSH
Process and interpretation[edit]

The TRH test involves administration of a small amount of TRH intravenously,
[1]
following which levels of TSH will be measured at several subsequent time
points using samples of blood taken from a peripheral vein.
The test is used in the differential diagnosis of secondary and tertiary
hypothyroidism. First, blood is drawn and a baseline TSH level is measured.
Then, TRH is administered via a vein. After 30 minutes blood is drawn again and
the levels of TSH are measured and compared to the baseline. Some authors
recommend additional blood sampling at 15 minutes. In children, late blood
sampling at 60 to 120 minutes is necessary. An increase in the serum TSH level
following TRH administration means that the cause of the hypothyroidism is in
the hypothalamus (tertiary hypothyroidism), i.e. the hypothalamus is not
producing TRH. Therefore, when TRH is given exogenously, TSH levels
increase.If the increase in serum TSH level following TRH administration is
absent or very slight, then the cause of the hypothyroidism is in the anterior
pituitary gland, i.e. the pituitary is not secreting TSH. Therefore, even when TRH
is given exogenously, TSH levels do not rise as the pituitary is diseased. [citation needed]
Side effects and risks[edit]

TRH may cause nausea, vomiting and some patients experience an urge to
urinate.
Rarely, TRH may cause blood vessel constriction leading to hemorrhage in
patients with pre-existing pituitary tumors. Accordingly, patients should be
advised about the risks, albeit rare, of TRH testing. [2]
See also[edit]
 Thyrotropin-releasing hormone
References[edit]
1. ^ Moncayo H, Dapunt O, Moncayo R (2007). "Diagnostic accuracy of basal TSH
determinations based on the intravenous TRH stimulation test: an evaluation of 2570 tests
and comparison with the literature". BMC Endocr Disord. 7: 5. doi:10.1186/1472-6823-7-
5. PMC 1950865. PMID 17678551.
2. ^ "MyThyroid.com: TRH Test". MyThyroid.com. 2005-05-31. Retrieved 2009-03-04.
3. http://www.auburn.edu/~deruija/endo_thyroidfts.pdf
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TRH stimulation test

From Wikipedia, the free encyclopedia

TRH stimulation test

Purpose assessing the degree of suppression in suspected

Prior to the availability of sensitive TSH assays, thyrotropin releasing

 1Differential diagnosis use

Differential diagnosis use[edit]

Process and interpretation[edit]

Side effects and risks[edit]

Test and procedures involving the endocrine system

Sestamibi parathyroid scan

TRH stimulation test

ACTH stimulation test

Captopril suppression test

uid deprivation test

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