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Interference in thyrotropin (TSH) determination: falsely elevated TSH values in a transplanted patient
J Seghers1, F Schrurs, P De Nayer
1Nuclear Medicine Department, Louvain University, Medical School, Brussels, Belgium.
European Journal of Nuclear Medicine
|January 1, 1989
Summary
A kidney transplant patient on OKT3 therapy experienced falsely high thyroid-stimulating hormone (TSH) levels due to antimouse antibodies. These antibodies interfered with the TSH immunoassay, highlighting a potential diagnostic challenge in immunocompromised patients.
Area of Science:
- Clinical Chemistry
- Immunology
- Nephrology
Background:
- Thyroid-stimulating hormone (TSH) assays are crucial for monitoring thyroid function.
- Immunosuppressive therapy, such as OKT3 (mouse monoclonal antibody), is used post-kidney transplantation to prevent rejection.
- Interference in immunoassays can lead to inaccurate diagnostic results.
Observation:
- A patient with a history of thyroidectomy and kidney transplant presented with a falsely elevated TSH level.
- The elevated TSH value was inconsistent with the patient's thyroid hormone levels.
- The patient was receiving OKT3 therapy for transplant rejection.
Findings:
- Antimouse antibodies (human immunoglobulins against mouse IgG2a and IgG2b) were detected in the patient's serum.
- Repeating the TSH assay with normal mouse serum yielded a true TSH value.
- Falsely elevated TSH immunoreactivity was localized to the IgG fraction of the patient's serum via protein-A chromatography.
Implications:
- Monoclonal antibody therapies can cause heterophile antibody interference in TSH immunoassays.
- Clinical laboratories must be aware of potential interferences in immunoassay results, especially in patients on specific therapies.
- Accurate TSH measurement is vital for managing patients with thyroid conditions, particularly those undergoing transplantation and immunosuppression.