Thyroxine-binding globulin (TBG) is the main responsible for serum thyroid hormone transport. Serum variations in TBG concentrations determine proportional variations in serum total T4 and T3 concentrations, without implications to function, since the free fraction remains normal. Several frequent clinical conditions lead to significant alterations in the TBG levels, being the most important variations due to genetic defects. Since TBG is codified by a gene localized in the X chromosome, the defects are more often found in males. We describe the development of an immunofluorometric assay for the measurement of TBG based on monoclonal antibodies, being one developed at our laboratories and the other obtained from commercial sources. The method presents sensitivity of 0.8mg/l and intra and inter-assay coefficients of variation of less than 10%. Comparison with a commercial assay showed high correlation (r = 0.93, n = 48), with normal values between 10mg/l and 29 mg/l. We also studied 20 individuals with congenital deficiency of TBG, 19 men and one woman, that presented normal TSH values and low total T4 values; in all of them the TBG values were undetectable. Free T4 values otherwise were high when measured with an indirect method in 16 of the individuals, and normal in the other four patients where they were measured with a direct post-dialysis method. Our results reinforce the practical need for an assay for the measurement of serum TBG for the diagnostic definition of some special cases, mainly when a direct free T4 assay is not available.
Thyroxine-binding globulin; Immunofluorometric assay; Congenital TBG deficiency; Free thyroxine assays
