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Oliveira JM, Alves TG, Camacho CP, Vieira JGH, Martins JRM. Elevated TSH in a Thyroidectomized Patient: Differential Diagnosis Beyond Noncompliance with Treatment. J Appl Lab Med 2019; 3:903-908. [PMID: 31639765 DOI: 10.1373/jalm.2018.026542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Julia M Oliveira
- Center of Thyroid Diseases and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
| | - Thalita G Alves
- Center of Thyroid Diseases and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil.,Molecular Biology Unit, Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
| | - Cléber P Camacho
- Center of Thyroid Diseases and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
| | - José Gilberto H Vieira
- Center of Thyroid Diseases and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
| | - João Roberto M Martins
- Center of Thyroid Diseases and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil; .,Molecular Biology Unit, Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
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Alves TG, Kasamatsu TS, Yang JH, Meneghetti MCZ, Mendes A, Kunii IS, Lindsey SC, Camacho CP, Dias da Silva MR, Maciel RMB, Vieira JGH, Martins JRM. Macrocalcitonin Is a Novel Pitfall in the Routine of Serum Calcitonin Immunoassay. J Clin Endocrinol Metab 2016; 101:653-8. [PMID: 26647152 DOI: 10.1210/jc.2015-3137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Calcitonin (CT) is a sensitive marker of medullary thyroid carcinoma (MTC) and is used for primary diagnosis and follow-up after thyroidectomy. However, persistently elevated CT is observed even after complete surgical removal without evidence of a recurrent or persistent tumor. OBJECTIVE To investigate the presence of assay interference in the serum CT of MTC patients who are apparently without a structural disease. PATIENTS AND METHODS We studied three index MTC cases for CT assay interference and 14 patients with metastatic MTC. The CT level was measured using an immunofluorometric assay. Screening for assay interference was performed by determination of CT levels before and after serum treatment with polyethylene glycol. Additionally, samples were analyzed by chromatography on ultra-performance liquid chromatography and protein A-Sepharose. RESULTS Patients with biochemical and structural disease showed CT mean recovery of 84.1% after polyethylene glycol treatment, whereas patients suspected of interference showed recovery from 2-7%. The elution profile on UPLC showed that the immunometric CT from these three patients behaved like a high molecular mass aggregate (>300 kDa). Additionally, when these samples were applied to the protein A-Sepharose, CT immunoreactivity was retained on the column and was only released after lowering the pH. CONCLUSIONS For the first time, our results show the presence of a novel pitfall in the CT immunoassay: "macrocalcitonin." Its etiology, frequency, and meaning remain to be defined, but its recognition is of interest and can help clinicians avoid unnecessary diagnostic investigations and treatment during the follow-up of MTC.
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Affiliation(s)
- Thalita G Alves
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Teresa S Kasamatsu
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Ji H Yang
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Maria Cecília Z Meneghetti
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Aline Mendes
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Ilda S Kunii
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Susan C Lindsey
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Cléber P Camacho
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Magnus R Dias da Silva
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - Rui M B Maciel
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - José Gilberto H Vieira
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
| | - João Roberto M Martins
- Thyroid Disease Center and Laboratory of Molecular and Translational Endocrinology (T.G.A., T.S.K., J.H.Y., I.S.K., S.C.L., C.P.C., M.R.D.d.S., R.M.B.M., J.G.H.V., J.R.M.M.), Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04039-032 São Paulo, SP, Brazil; and Molecular Biology Division (T.G.A., M.C.Z.M., A.M., J.R.M.M.), Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, 04044-020 São Paulo, SP, Brazil
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Ikegami K, Liao XH, Hoshino Y, Ono H, Ota W, Ito Y, Nishiwaki-Ohkawa T, Sato C, Kitajima K, Iigo M, Shigeyoshi Y, Yamada M, Murata Y, Refetoff S, Yoshimura T. Tissue-specific posttranslational modification allows functional targeting of thyrotropin. Cell Rep 2014; 9:801-10. [PMID: 25437536 PMCID: PMC4251493 DOI: 10.1016/j.celrep.2014.10.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/04/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022] Open
Abstract
Thyroid-stimulating hormone (TSH; thyrotropin) is a glycoprotein secreted from the pituitary gland. Pars distalis-derived TSH (PD-TSH) stimulates the thyroid gland to produce thyroid hormones (THs), whereas pars tuberalis-derived TSH (PT-TSH) acts on the hypothalamus to regulate seasonal physiology and behavior. However, it had not been clear how these two TSHs avoid functional crosstalk. Here, we show that this regulation is mediated by tissue-specific glycosylation. Although PT-TSH is released into the circulation, it does not stimulate the thyroid gland. PD-TSH is known to have sulfated biantennary N-glycans, and sulfated TSH is rapidly metabolized in the liver. In contrast, PT-TSH has sialylated multibranched N-glycans; in the circulation, it forms the macro-TSH complex with immunoglobulin or albumin, resulting in the loss of its bioactivity. Glycosylation is fundamental to a wide range of biological processes. This report demonstrates its involvement in preventing functional crosstalk of signaling molecules in the body.
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Affiliation(s)
- Keisuke Ikegami
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Xiao-Hui Liao
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Yuta Hoshino
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Hiroko Ono
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Wataru Ota
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Yuka Ito
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan; Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Taeko Nishiwaki-Ohkawa
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan; Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Chihiro Sato
- Laboratory of Animal Cell Function, Bioscience and Biotechnology Center and Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Ken Kitajima
- Laboratory of Animal Cell Function, Bioscience and Biotechnology Center and Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Masayuki Iigo
- Department of Applied Biological Chemistry, Faculty of Agriculture, C-Bio, and CORE, Utsunomiya University, 350 Mine-machi, Utsunomiya 321-8505, Japan
| | - Yasufumi Shigeyoshi
- Department of Anatomy and Neurobiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
| | - Yoshiharu Murata
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Samuel Refetoff
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; Department of Pediatrics and Committee on Genetics, The University of Chicago, Chicago, IL 60637, USA.
| | - Takashi Yoshimura
- Laboratory of Animal Physiology, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan; Institute of Transformative Bio-Molecules (WPI-ITbM), Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan; Avian Bioscience Research Center, Graduate School of Bioagricultural Sciences, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan; Division of Seasonal Biology, National Institute for Basic Biology, 38 Nishigonaka, Myodaiji, Okazaki 444-8585, Japan.
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