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Factitious transient neonatal hyperthyrotropinemia.

N Jospe1, G D Berkovitz, L E Corcoran

  • 1Division of Pediatric Endocrinology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205.

Journal of Endocrinological Investigation
|February 1, 1988
PubMed
Summary
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A mother's sarcoidosis caused abnormal thyroid-stimulating hormone (TSH) levels in her infant due to interfering immunoglobulin G (IgG). This interference affected neonatal screening tests, highlighting potential diagnostic challenges.

Area of Science:

  • Endocrinology
  • Immunology
  • Neonatal Screening

Background:

  • Neonatal screening programs are crucial for early detection of congenital hypothyroidism.
  • Thyroid-stimulating hormone (TSH) assays are standard for neonatal thyroid function testing.
  • Maternal health conditions can potentially influence neonatal screening results.

Observation:

  • An infant presented with elevated TSH levels detected by one specific neonatal screening laboratory.
  • The infant's TSH levels normalized spontaneously by six months of age.
  • The infant's mother, with a history of sarcoidosis, exhibited factitious hyperthyrotropinemia in the same laboratory.

Findings:

  • Gel chromatography and ammonium sulfate precipitation identified an immunoglobulin G (IgG) as the cause of factitious hyperthyrotropinemia in the maternal serum.

Related Experiment Videos

  • Treatment of maternal serum with polyethylene glycol normalized TSH levels, confirming the immunoglobulin interference.
  • Standard immunological tests including protein electrophoresis and immunofixation electrophoresis were normal, suggesting a specific subclass of IgG was involved.
  • Implications:

    • This case highlights a potential source of false-positive neonatal TSH screening results.
    • Sarcoidosis may be associated with specific IgG subclasses that interfere with certain TSH immunoassays.
    • Further investigation into assay interference by specific immunoglobulin subclasses is warranted for accurate neonatal thyroid screening.