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A radioimmunoassay for urinary human chorionic gonadotropin (hCG) which used antiserum to the hCGβ carboxy-terminal peptide was employed to detect hCG production in women with gestational trophoblastic disease. The urinary hCG assay was considerably more effective in detecting increased hCG production, and, hence, persistent tumor burden, than the commonly used serum hCGβ subunit radioimmunoassay. In two women treated for choriocarcinoma, urinary hCG levels remained distinctly elevated for 2 to 6 weeks, even though the serum hCG level was undetectable; in both cases, the urinary hCG radioimmunoassay reliably predicted the eventual reappearance of hCG in the serum. In six women whose disease remitted, the urinary hCG level declined to the normal range during chemotherapy, and remained there afterward. In eight patients who had been in remission for periods of from 1 to 14 years, urinary hCG levels were in the normal range. We conclude that this highly sensitive and reliable method for the detection of hCG production improves the ability to diagnose persistent trophoblastic disease.

We intensively studied 30 women attempting pregnancy in order to lay groundwork for larger studies of early pregnancy loss. These women collected first morning urine specimens for up to 6 months after discontinuing use of birth control. Urine specimens were successfully collected for 98% of the woman-days in the study. Three assays for human chorionic gonadotropin (hCG) were performed on each urine specimen. An immunoradiometric assay (IRMA) specific to the carboxy terminal peptide of the hCG β-chain proved to be more sensitive and more specific than two radioimmunoassays (RIAs). Using the IRMA, we found four cases in which hCG rose and fell over successive days, consistent with early pregnancy loss. For three of these four cases, the level of hCG was too low to be detectable with the RIAs. Among the control group of five women with tubal ligations, there was no detectable hCG above threshold with the IRMA. Thus, the enhanced sensitivity and specificity of the IRMA allows very early pregnancy losses to be identified that would otherwise be undetectable. Furthermore, its effectiveness with small quantities of first morning urine makes the IRMA a useful tool for epidemiologic studies.

• We gave graded doses of levothyroxine sodium to 11 elderly hypothyroid subjects (mean age, 66.1 years). The daily levothyroxine sodium dose was initially 75 μg or less, and was increased by 25 μg every six weeks. Serum total thyroxine, total triiodothyronine, and basal thyrotropin levels were measured at the start of the study and at the end of each six-week dose period. A protirelin (thyrotropin-releasing hormone) test was performed when the thyrotropin level returned to normal. Mean daily levothyroxine sodium doses that normalized serum thyrotropin levels and protirelin test were 110±8 μg and 113±9 μg, respectively. Serial basal thyrotropin determinations during stepwise increments in levothyroxine dose indicated physiologic hormone replacement. As determined in our elderly patients, levothyroxine replacement dose was a third less than that formerly recommended.(Arch Intern Med 1984;144:1752-1754)