text: The TRH test involves administration of a small amount of TRH intravenously, 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.