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Factitiously Elevated Total Triiodothyronine in a Euthyroid Patient with Multiple Myeloma
Kaushik Mandal1, Damilola Ashorobi1, Alice Lee1
1Division of Endocrinology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
Case Reports in Endocrinology
|September 9, 2021
Summary
Factitious elevations in thyroid hormones due to lab interference from multiple myeloma paraproteins can mislead diagnoses. This case highlights spurious total T3 results, complicating hypothyroidism management and underscoring platform variability.
Area of Science:
- Clinical Chemistry
- Endocrinology
- Hematology
Background:
- Thyroid hormone testing is crucial for managing hypothyroidism.
- Laboratory interference can lead to inaccurate thyroid hormone measurements.
- Multiple myeloma and paraproteinemia are known causes of such interference.
Observation:
- A patient with multiple myeloma and IgG paraproteinemia presented with factitious elevations in total T3 levels.
- This spurious elevation complicated the management of her hypothyroidism with levothyroxine.
- Discrepancies between different laboratory test platforms were noted.
Findings:
- The patient's IgG paraprotein interfered with the total T3 assay, causing falsely high results.
- This interference mimicked hyperthyroidism, despite the patient being euthyroid on appropriate levothyroxine dosage.
- Variations in assay methodologies across manufacturers can contribute to spurious results.
Implications:
- Clinicians must be aware of potential laboratory interferences in thyroid hormone testing, especially in patients with multiple myeloma.
- Erroneous thyroid hormone levels can lead to misdiagnosis and inappropriate treatment adjustments.
- Consideration of assay interference and inter-platform differences is essential for accurate patient management.
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