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Goettemoeller T, McShane AJ, Rao P. Misleading FT4 and FT3 Due to Immunoassay Interference From Autoantibodies. Clin Biochem 2021; 101:16-18. [PMID: 34848174 DOI: 10.1016/j.clinbiochem.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immunoassays used to measure total and free thyroxine (T4 and FT4) and total and free triiodothyronine (T3 and FT3) can provide inaccurate results due to interference from endogenous autoantibodies. CASE REPORT A 74-year-old female treated for hypothyroidism with levothyroxine replacement had elevated thyroid stimulating hormone (TSH), FT4, and FT3. Due to concern for hyperthyroidism, levothyroxine was discontinued and further workup was initiated. A pituitary MRI revealed a microadenoma but the alpha-subunit was normal. She was given octreotide for suspected TSH secreting pituitary adenoma without improvement in her TSH, FT4, or FT3 levels. She was referred to our clinic, where inaccurate lab values for FT4 and FT3 were suspected. RESULTS Testing via equilibrium dialysis liquid chromatography tandem mass spectrometry (LC-MS/MS) method revealed lower levels of FT4 and FT3. Subsequent testing included heterophile blocking tube treatment, polyethylene glycol (PEG) precipitation, and anti-T3/T4 autoantibody levels. The tests revealed thyroid hormone autoantibodies (THAAs) as the cause of immunoassay interference. CONCLUSIONS When thyroid hormones are elevated and TSH is not suppressed, confirmatory testing with another method such as equilibrium dialysis LC-MS/MS, which is not susceptible to interference from autoantibodies, should be considered.
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Affiliation(s)
- Travis Goettemoeller
- Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Adam J McShane
- Department of Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Pratibha Rao
- Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Jiménez García C, Ortega Fernández P, Torregrosa Quesada ME, González Bueno V, Botella Belda MT, Guerra RA. False hyperthyroidism caused by interference in immunoassays. ADVANCES IN LABORATORY MEDICINE 2021; 2:121-128. [PMID: 37359205 PMCID: PMC10197363 DOI: 10.1515/almed-2020-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/20/2020] [Indexed: 06/28/2023]
Abstract
Objectives Immunoassays used to assess thyroid function are vulnerable to different types of interference that may affect clinical decision-making. Case presentation We report the case of a 37-year-old woman who developed iatrogenic hypothyroidism after having received radioiode therapy who visited our hospital for her annual checkup. The patient was asymptomatic, without signs suggestive of thyroid disease. However, laboratory analysis proved otherwise: thyrotropin (TSH) 7.75 mU/L, thyroxine (FT4) >7.7 ng/dL. Conclusions The inconsistency between her clinical symptoms and the biochemistry data raised the possibility of a methodological interference. A thorough evaluation of the main causes of interference was conducted in the laboratory to exclude the presence of interference in TSH and FT4. Finally, different interfering agents were identified, which affected free thyroid hormone and TSH determination.
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Affiliation(s)
- Clara Jiménez García
- Laboratory of Hormones, Hospital General Universitario de Alicante, Pintor Baeza 11, Alicante, Spain
| | - Piedad Ortega Fernández
- Laboratory of Clinical Chemistry, Hospital General Universitario de Elche, Almazara, Elche, Spain
| | | | - Victoria González Bueno
- Laboratory of Hormones, Hospital General Universitario de Alicante, Pintor Baeza 11, Alicante, Spain
| | | | - Rocío Alfayate Guerra
- Laboratory of Hormones, Hospital General Universitario de Alicante, Pintor Baeza 11, Alicante, Spain
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Dahll LK, Haave EM, Dahl SR, Aas FE, Thorsby PM. Endogenous anti-streptavidin antibodies causing erroneous laboratory results more common than anticipated. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:92-103. [DOI: 10.1080/00365513.2020.1858493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Louise K. Dahll
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Ellen Marie Haave
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Sandra R. Dahl
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Finn Erik Aas
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Per M. Thorsby
- The Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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Favresse J, Stoefs A, Bayart JL, Burlacu MC, Maisin D, Maiter D, Gruson D. A Challenging Case of Falsely Elevated Free Thyroid Hormones. J Appl Lab Med 2020; 5:406-411. [PMID: 32445369 DOI: 10.1093/jalm/jfz027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Anke Stoefs
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Maria-Cristina Burlacu
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Diane Maisin
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium.,Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
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Favresse J, Burlacu MC, Maiter D, Gruson D. Interferences With Thyroid Function Immunoassays: Clinical Implications and Detection Algorithm. Endocr Rev 2018; 39:830-850. [PMID: 29982406 DOI: 10.1210/er.2018-00119] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/08/2018] [Indexed: 12/22/2022]
Abstract
Automated immunoassays used to evaluate thyroid function are vulnerable to different types of interference that can affect clinical decisions. This review provides a detailed overview of the six main types of interference known to affect measurements of thyroid stimulating hormone (TSH), free thyroxine (T4) and free triiodothyronine (T3): macro-TSH, biotin, antistreptavidin antibodies, anti-ruthenium antibodies, thyroid hormone autoantibodies, and heterophilic antibodies. Because the prevalence of some of these conditions has been reported to approach 1% and the frequency of testing for thyroid dysfunction is important, the scale of the problem might be tremendous. Potential interferences in thyroid function testing should always be suspected whenever clinical or biochemical discrepancies arise. Their identification usually relies on additional laboratory tests, including assay method comparison, dilution procedures, blocking reagents studies, and polyethylene glycol precipitation. Based on the pattern of thyroid function test alterations, to screen for the six aforementioned types of interference, we propose a detection algorithm, which should facilitate their identification in clinical practice. The review also evaluates the clinical impact of thyroid interference on immunoassays. On review of reported data from more than 150 patients, we found that ≥50% of documented thyroid interferences led to misdiagnosis and/or inappropriate management, including prescription of an unnecessary treatment (with adverse effects in some situations), inappropriate suppression or modification of an ongoing treatment, or use of unnecessary complementary tests such as an I123 thyroid scan. Strong interaction between the clinician and the laboratory is necessary to avoid such pitfalls.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Maria-Cristina Burlacu
- Service d'Endocrinologie et Nutrition, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Service d'Endocrinologie et Nutrition, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium.,Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium.,Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
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Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine , University-Hospital of Padua , Via Giustiniani 2 , 35128 Padua , Italy , Phone: +39 0498212792, Fax: +39 049663240
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