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Falsely Elevated Thyroid-Stimulating Hormone Results due to Interference by M-Component of IgG-Lambda Type.

Anders Larsson1, Mats Gåfvels1, Torbjörn Karlsson2

  • 1Section of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

Case Reports in Oncology
|August 11, 2020
PubMed
Summary

Monoclonal immunoglobulin components (M-components) can interfere with lab tests, leading to inaccurate results. This case shows an M-component causing falsely high thyroid-stimulating hormone (TSH) levels in a myeloma patient.

Keywords:
Erroneous laboratory test resultM-componentMyelomaPEG- precipitationThyroid-stimulating hormone

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Area of Science:

  • Clinical Chemistry
  • Immunology
  • Endocrinology

Background:

  • Laboratory test interference can lead to misdiagnosis and inappropriate treatment.
  • Monoclonal immunoglobulin components (M-components), often associated with multiple myeloma, are known to cause analytical interferences.
  • Elevated thyroid-stimulating hormone (TSH) is a common indicator for thyroid dysfunction.

Observation:

  • A 75-year-old male patient with myeloma presented with persistently elevated TSH levels.
  • Thyroid marker analysis revealed a strong correlation between IgG concentrations and TSH values (R² = 0.724).
  • The highest recorded TSH level was 75 mIU/L.

Findings:

  • Polyethylene glycol (PEG) precipitation, used to remove intact immunoglobulins, normalized the TSH results.
  • This indicated that the M-component (IgG-lambda type) was causing analytical interference, not true hyperthyroidism.
  • The interference mechanism involved the M-component directly affecting TSH immunoassay measurements.

Implications:

  • Clinicians and laboratory professionals must be aware of M-component interference in immunoassays.
  • Consideration of M-components is crucial when interpreting abnormal thyroid function tests, especially in patients with hematological malignancies.
  • Implementing specific diagnostic strategies, like PEG precipitation, can help identify and circumvent M-component-related assay interferences.