Serum diiodotyrosine - a biomarker to differentiate destructive thyroiditis from Graves' disease.

OBJECTIVE: Conventional diagnostic methods are limited in their ability to differentiate destructive thyroiditis from Graves' disease. We hypothesised that serum diiodotyrosine (DIT) and monoiodotyrosine (MIT) levels could be biomarkers for differentiating destructive thyroiditis from Graves' disease. DESIGN: Patients with destructive thyroiditis (n = 13) and Graves' disease (n = 22) were enrolled in this cross-sectional study. METHODS: We assayed the serum DIT and MIT levels using liquid chromatography-tandem mass spectrometry. A receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of the serum DIT and MIT levels as biomarkers for differentiating destructive thyroiditis from Graves' disease. RESULTS: The serum DIT and MIT levels were significantly higher in patients with destructive thyroiditis than in those with Graves' disease. The ROC curve analysis showed that the serum DIT levels (≥359.9 pg/mL) differentiated destructive thyroiditis from Graves' disease, significantly, with 100.0% sensitivity and 95.5% specificity (P < 0.001). The diagnostic accuracy of the serum MIT levels (≥119.4 pg/mL) was not as high as that of the serum DIT levels (sensitivity, 84.6%; specificity, 77.3%; P = 0.001). CONCLUSIONS: The serum DIT levels may serve as a novel diagnostic biomarker for differentiating destructive thyroiditis from Graves' disease.

[The study of the metabolism of iodotyrosines included in the iodized milk protein in rats].

In the course of evolution in animals and humans, a complex and effective system for providing the body with iodine in the form of various organic and inorganic compounds was developed. The metabolism of inorganic iodine has been studied quite well, in contrast to the mechanism of assimilation of its organic compounds. Among the latter, iodotyrosines, which are part of iodinated milk proteins, are of particular interest. To distinguish the peculiarities of the biotransformation of iodotyrosines in the animals' organism, their concentration and the concentration of tyrosine in blood plasma of rats after single administration of iodinated milk proteins were determined. For comparison, in parallel a group of animals received potassium iodide. The tested preparations were administered intragastrically with a probe in the form of aqueous solutions at a dose equivalent to 30 µg iodine per 1 kg of body weight. The level of mono- and diiodotyrosine in rat blood plasma was determined by HPLC with a mass spectrometer detector. The tyrosine content was determined on an automatic amino acid analyzer. The registration of the indices was carried out before the administration and 1, 4 and 24 hours after the administration of the substances. In the course of the conducted studies it was found that when iodinated milk proteins are once administered, a significant increase in the concentrations of monoiodotyrosine and diiodotyrosine is observed. The maximum level of iodinated amino acids, exceeding the control values by more than 6 fold, was recorded 4 hours after the ingestion of iodine-containing organic compounds into the body. At the same time interval, an increase in the concentration of tyrosine was observed in one of the experimental groups receiving iodinated milk protein. The simultaneous presence of tyrosine and its iodinated derivatives in blood plasma may indicate that monoiodotyrosine and diiodotyrosine are capable of being absorbed into the systemic bloodstream without metabolic transformations in the liver. Under introduction of potassium iodide, an increase in blood plasma concentration of monoiodotyrosine by 35% compared to the control was observed only after 24 hours, which may be a consequence of the activation of the thyroid gland due to the intake of an increased amount of iodine.

Iodine speciation in human serum by reversed-phase liquid chromatography-ICP-mass spectrometry.

Reversed-phase liquid chromatography-inductively coupled plasma mass spectrometric hyphenation was used for iodine speciation in human serum. First investigations showed that iodine species nearly quantitatively were eluted in the void volume. The result indicated that protein-linked thyroid hormones were not interacting with the stationary phase, thus being not retained. Investigations were performed about T4-TBG (thyroxin-thyroxin-binding globulin) complex generation and its retention during chromatography. It was shown that T4-TBG was not retained on the column. Therefore, a protease treatment was introduced for serum sample preparation. The analysis of "normal" sera (after protease) gave reasonable results lying in the range published in literature: I-:11; di-iodothyrosine (DIT): 2.1; mono-iodothyrosine (MIT): 1.6; reversed tri-iodothyronine (rT3): 3.9; T3: 5.9; T4: 60; each micrograms iodine per liter. The method also proved to recognize abnormalities in a pathologic serum, having rT3 as the predominant species. In this case the method obviously was superior compared to standard immunoassay methods, as it is monitoring the iodine in the species (physiologically active iodine species), whereas immunoassay methods may sometimes detect deiodinated (inactive) compounds.

Daily changes in thyroid activity in the frog Rana perezi: variation with season.

Plasma triiodothyronine (T3) and thyroxine (T4) levels, as well as thyroid free (f) and bound (b) thyroid hormones (TH) content, were determined by radioimmunoassay (RIA) in adult Rana perezi frogs during a 24 h cycle in winter, spring, summer, and autumn. Significant daily changes in plasma T3 levels were present in all the seasons except for winter, being the lowest values observed during the scotophase. In contrast, plasma T4 only showed significant changes in spring, following a similar pattern to the one described for T3. Thyroid fT3 content did present day/night significant changes only in spring showing high contents at early scotophase. Mean fT4 content was higher at the beginning of light phase than during the rest of daily photocycle in spring and autumn, but significant differences appeared only in autumn. Regarding the thyroid bound content of TH, bT3, and bT4 presented significant daily changes in spring and autumn. However, different profiles were observed in these two seasons. High bound contents were found at early photo- and scotophase with lower values at late dark phase in spring, whereas higher contents were detected at this time in autumn. The present results indicate the existence of seasonally changing daily fluctuations in thyroid activity in Rana perezi and it seems that an interaction between photoperiod and temperature plays a role in the regulation of these daily changes.

Elevated serum diiodotyrosine (DIT) in severe infections and sepsis: DIT, a possible new marker of leukocyte activity.

Ether link cleavage (ELC) of T4 yielding diiodotyrosine (DIT) has recently been shown in vitro to be the major pathway of T4 metabolism in phagocytosing leukocytes. To evaluate this pathway in vivo and the possible clinical relevance of DIT measurements in diseases with increased leukocyte activity, radioimmunological studies on serum levels of DIT and other thyroid parameters were performed in 125 critically ill patients classified into 3 groups with bacterial infections according to the severity of infection and 1 group without infections. While the pattern of iodothyronine and TSH levels typical for severe nonthyroidal disorders, i.e. decreased total T3 and elevated rT3, normal or decreased total T4 and TSH, and normal free T4, was found in all four groups of intensive care patients studied, elevated serum DIT was observed only in those patients whose clinical course was complicated by severe bacterial infections. Serial measurements revealed a close temporal connection between the infection phase and increased DIT levels. Median values and 16th to 84th percentile ranges (in parentheses) of serum DIT (normal range, 0.02-0.55 nmol/L) were as follows: sepsis, 1.38 (0.32-5.14); severe nonsystemic infections such as peritonitis and abscesses, 3.84 (0.24-17.2); moderate infections such as pneumonia and tracheobronchitis, 0.44 (0.18-1.16); and critical illness without infections, 0.14 (0.08-0.30) nmol/L. These elevations of circulating DIT could neither be correlated with changes in renal function nor attributed to drug effects. The results of the present study do not allow any definitive conclusions to be made about the mechanisms underlying the phenomenon of increased serum DIT levels in infections. Apart from this open question, DIT appears to be a relatively specific serum parameter for the presence and course of severe bacterial inflammations. Its measurement could provide useful clinical information, particularly for monitoring the time course of deep-seated infections.

[Binding of 3H-alanine and 125I-diiodotyrosine with serum proteins in vitro and in vivo]. / Sviazyvanie 3H-alanina i 125I-diiodtirozina belkami syvorotki krovi v opytakh in vitro i in vivo.

Considerable amount of complexes, formed after binding of 3H-alanine and 125I-diiodotyrosine with blood serum proteins in vivo and in vitro was found to dissociate as a result of gel filtration on microcolumns of Sephadex G-25 in presence of 8 M urea. The phenomenon observed may be considered among possible reasons responsible for overestimation of the adsorption rate of food proteins antigens in gastrointestinal tract of experimental animals.

Response of total and 'free' thyroid hormones and diiodotyrosine to bovine TSH in subclinical hypothyroidism.

Thirty-three patients with Addison's disease were studied. Twenty-two had idiopathic Addison's disease; within this group, 14 patients had clinical or subclinical hypothyroidism, and 16 had increased titres of thyroid autoantibodies. Five patients had tuberculous, and eight had unclassifiable Addison's disease; only one patient in the latter group had evidence of thyroid autoimmunity. A stimulation test with 15 mU bTSH/kg was performed in three patients with Schmidt's syndrome (coexisting Addison's disease and manifest primary hypothyroidism), 15 patients with either subclinical hypothyroidism or increased titres of thyroid autoantibodies, 10 patients without thyroid involvement, and 10 normal controls. There was no detectable increase of 'free' and total thyroid hormones in Schmidt's syndrome. The mean increases after 3-4 h of T4, fT4, T3 and fT3 were 22, 35, 63 and 66%, respectively, in patients without thyroid involvement, and 13, 24, 46 and 45% in patients with subclinical hypothyroidism. 'Free' but not total thyroid hormones rose significantly (P less than 0.01) higher in patients without signs of thyroid involvement than in patients with subclinical hypothyroidism and/or thyroid autoantibodies. Thyroid hormone response to bTSH in Addison's disease with apparently healthy thyroid glands was not different from normal controls. Serum diiodotyrosine rose in all groups except in hypothyroidism; hypothyroid patients had, however, basal levels well within the normal range. Thus, thyroid hormone synthesis appears to be blocked at a point distal to diiodotyrosine formation in this particular situation. These results support the assumption that TSH elevation in idiopathic Addison's disease is due to coexisting thyroid autoimmunity and that it reflects incipient thyroid failure.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo formation of diiodotyrosine by extrathyroidal thyroxine ether-link cleavage and effects of mononitrotyrosine on this pathway in the rat.

The formation of DIT from T4 was quantitatively studied in thyroidectomized (T) rats given 16 micrograms synthetic T4 daily. Measurement of the elimination of radioiodinated DIT and T4 tracers from serum yielded MCRs of 19.0 ml/h X 100 g body weight for DIT and 0.65 ml/h X 100 g body weight for T4. Mean serum concentrations +/- SD (nanomoles per liter; n = 8) measured by RIA 24 and 48 h after the last T4 administration were as follows: DIT, 0.243 +/- 0.130 and 0.150 +/- 0.070, respectively; T4, 173 +/- 34 and 97 +/- 20, respectively. In T rats which had not received T4, DIT and iodothyronines in serum were undetectable. From the results of kinetic studies and RIA measurements, the fraction of circulating T4 converted to DIT was calculated to be 3.9-4.3%. After administration of the iodotyrosine inhibitor 3-nitro-L-tyrosine (MNT) to T4-treated T rats at a dosage of 50 mumol/day for 1 week or longer, it was possible to observe, on the one hand, the expected delay of DIT tracer elimination from serum resulting in a decreased MCR of 9.9 ml/h X 100 g body weight. On the other hand, MNT treatment led to a strong decline of DIT serum levels below the detection limit in all animal groups. This effect of MNT on the peripheral T4-to-DIT conversion requires further studies using other experimental systems for confirmation and elucidation of its mechanism. It is concluded that peripheral DIT formation in the animal model used occurs via ether-link cleavage of administered T4 and/or some of its iodothyronine metabolites. On the basis of data from recent studies, the peripheral DIT turnover resulting from iodothyronine degradation can be estimated to be about 35% in intact rats. Our data confirm the in vivo generation of extrathyroidal DIT from T4 in the rat. Although the experiments were performed at unphysiologically high T4 serum levels and our quantitative data, therefore, cannot be applied to euthyroid conditions with absolute certainty, the results suggest that ether-link cleavage of T4 yielding DIT is not an insignificant pathway of peripheral T4 metabolism in the rat.

IgG purification to measure the level of an iodinated thyroglobulin peptide, the 3,5,3',5' tetraiodo-l-tyrosyl-l-tyrosine in human serum.

Antibodies reacting with 3,5,3',5' tetraiodo-l-tyrosyl-l-tyrosine (I2Tyr-I2Tyr) were elicited in rabbits by immunization with an oxidized yeast conjugate coupled with I2Tyr-I2Tyr. Ion-exchange chromatography was used to purify immunoglobulins, in order to improve the specificity in measurement of I2Tyr-I2Tyr level in patient serum. IgG binding capacity versus I2Tyr-I2Tyr was considerably increased after immunoglobulin purification.

Effects of small doses of bovine TSH on serum levels of free and total thyroid hormones, their degradation products, and diiodotyrosine.

Bovine TSH was administered iv to 10 normal volunteers in doses of 2.5, 7.5, 15 and 30 mU/kg. Brisk elevations of serum diiodotyrosine occurred already after the smallest dose (mean, +183%) while larger doses had only slight additional effects. T3 rose much higher than T4 (+71% compared to +23% after 15 mU bTSH/kg), and free thyroid hormones exhibited changes similar to total T3 and total T4. The mean absolute increase in serum fT3 ranged from 2.03 to 9.04 pmol/l and proved to be an easily measurable parameter for the TSH effect. Dose-response effects were seen for the increase of fT4, fT3 and T3. TBG and rT3 did not change but the degradation product 3,3'-T2 showed large increments of serum levels. There was no correlation between the response of T3 and T4, fT3 and fT4, or diiodotyrosine and any of the other parameters of thyroid function. The interindividual differences in the magnitude of thyroid hormone response to TSH were considerable, and there was no relationship between this response and thyroid volume by ultrasound. We conclude that direct stimulation of the thyroid gland with bTSH in small doses leads to consistent increases of thyroid hormones, especially T3 and fT3, that the response varies between individuals, and that the precursor diiodotyrosine is released together with thyroid hormones.

Effects of iodotyrosine deiodinase inhibition on serum concentrations and turnover of diiodotyrosine (DIT) and thyroxine (T4) in the rat.

Serum concentrations and metabolic clearance rates (MCR) of diiodotyrosine (DIT) and thyroxine (T4) have been measured by radioimmunoassay and tracer kinetic technique in both normal rats and rats treated with 3-nitro-L-tyrosine (MNT), a potent inhibitor of iodotyrosine deiodinase. In normal rats, DIT serum levels were 0.27 +/- 0.12 nmol/l (mean +/- SD); MCR was 15.9 ml/h . 100 g body weight (bw), and the turnover rate was 4.3 pmol/h . 100 g bw. Inhibition of iodotyrosine deiodination by treatment with 50 mumol MNT per day for 1 week caused a highly significant elevation of DIT serum levels to 4.80 +/- 3.30 nmol/l, a decrease of MCR to 9.0 ml/h . 100 g bw and a ten-fold increase of the DIT turnover rate to 43.2 pmol/h . 100 g bw. Serum concentrations of T4 and T3 decreased slightly, whereas the T4 turnover rate (37.5 vs 37.8 pmol/h . 100 g bw) and rT3 serum levels remained unchanged under MNT treatment. The study demonstrates the presence of measurable DIT serum concentrations in the normal rat. Inhibition of intra- and extrathyroidal iodotyrosine deiodinase leads to a situation in which circulating iodotyrosines play an equally important role in peripheral iodine turnover as the iodothyronines. Since DIT serum levels in normal and enzyme-blocked rats were comparable to those in normal human subjects and patients with iodotyrosine deiodinase defect respectively, MNT-treated rats afford a suitable experimental model for this disease.

Circulating diiodotyrosine: studies of its serum concentration, source, and turnover using radioimmunoassay after immunoextraction.

This report describes the application of a sensitive, specific, and reproducible RIA for diiodotyrosine (DIT) in human serum and metabolic studies on the source and kinetics of circulating DIT. Interference by cross-reactivity of T4 and other analogs was completely eliminated by isolation of DIT from serum with an efficient preparative immunoprecipitation technique. Mean (+/- SD) serum DIT levels were 161 +/- 133 pmol/liter (7.0 ng/100 ml) in 41 normal subjects, 64 +/- 30 pmol/liter in 46 pregnant women, 241 +/- 83 pmol/liter in the cord serum of 48 newborn infants, 542 +/- 494 pmol/liter in 22 hyperthyroid patients, and 101 +/- 71 pmol/liter in 15 hypothyroid patients. Mean values in pregnant, newborn and hyperthyroid subjects were significantly different from the normal mean. Very low DIT serum levels were found in four athyreotic patients during oral T4 substitution therapy, indicating that little DIT is formed by peripheral T4 degradation. In five normal subjects who received a single oral dose of 3 mg T4, serum DIT remained unchanged in one case and decreased in four cases. Radioimmunological measurements of DIT elimination from serum after the iv injection of 1 mg DIT in two normal volunteers gave MCRs of 103 and 133 liters/day and an average extrathyroidal DIT turnover rate of 19 nmol/day (8.2 microgram/day). These data indicate that circulating DIT arises predominantly from the thyroid, suggesting that peripheral formation of DIT is a minor metabolic pathway in the human.

Gas-liquid chromatographic determination of mono- and diiodotyrosines in serum.

A sensitivie, reliable gas-chromatographic assay for monoiodotyrosine and diiodotyrosine in human serum is reported. The oxazolidinone-heptafluorobutyric anhydride derivatives allow the quantitation of both compounds in the linear range of 0.2 to 7.6 mg/L of serum. Analytical recovery averaged 88%, and mean accuracy and within-run precision were 98 and 2%, respectively. Concentrations of monoiodotyrosine in serum as low as 20 microgram/L and of diiodotyrosine as low as 100 microgram/L can be detected. Normal serum contains no detectable concentration of either compound, but the method is applicable as a diagnostic tool in the early prediction of thyroid disease. Both compounds were detected in the serum of a hypothyroid subject whose normal thyroid hormone concentrations were being maintained by therapy with desiccated thyroid extract.

Binding of 3,5-diiodotyrosine to serum proteins.

The reversible binding of 3,5-diiodotyrosine (DIT) to human and bovine serum protein and to purified human serum prealbumin and human and bovine albumin has been studied by equilibrium dialysis. Maximum binding occurred at pH 8.6-9.0. Human serum bound DIT less than did bovine serum. Adult ox and fetal calf sera showed similar binding. The main DIT-binding protein of human serum was prealbumin. It showed a single affinity site with a Ka of 0.85 X 10(6) M-1 at pH 8.6 and 0.40 X 10(6) M-1 at pH 7.4. The affinity constant of serum albumin for DIT was 2.8 X 10(3) M-1 at pH 8.6. The elevated binding of DIT to bovine serum is essentially due to albumin whose affinity constant for DIT is 16-times higher than that of human serum albumin. Fetuin was not responsible for any noticeable DIT binding in fetal calf serum.

Serum diiodotyrosine.

Serum diiodotyrosine (DIT) was measured by radioimmunoassay in healthy subjects patients with thyroid disease and a variety of laboratorty animals. Ninety-two healthy adults had a mean level of 101 ng/100 ml. There was no sex difference in DIT levels but DIT fell with aging. There was no change with short term oral SSKI administration. Athyrotic subjects had measurable but reduced levels (mean = 52 ng/100 ml). Hyperthyroid subjects had levels slightly, but not significantly, higher than controls (mean = 149 ng/100 ml). Treatment of hyperthyroidism was followed by a small but significant fall in DIT levels, but there was no change in DIT levels with thyroid hormone therapy of hypothyroidism. A large species variation in serum DIT levels was found among laboratory animals with mean levels ranging from 17 ng/100 ml in mice to 428 ng/100 ml in dogs.