Abstract:
RATIONALE:Thyroglobulin (Tg) is an accurate indicator of clinical outcome after total thyroidectomy in patients with differentiated thyroid carcinoma. Usually, Tg levels agree with whole body scan. However, in some patient, discordant results were found, often because of Tg immunoassay interference. Several reports indicated that 2-site immunoassay interference with heterophile antibodies (HAb) can lead to misinterpretation of the laboratory test result. PATIENT CONCERNS:We report a case of a 46-year-old woman referred to our endocrine clinic for markedly increased calcitonin (CT) without the associated clinical picture. The measurement was repeated with the same patient sample on a different analytical platform and the result was an undetectable CT level. The measurement of Tg was repeated on 3 different analytical platforms using chemiluminescence and electrochemiluminescence immunoassays and the results were different on each platform. HAb blocking tubes resulted in a different level of both CT and Tg, suggesting the presence of a heterophile substance in the serum sample. Further characterization showed reactivity to several animal species antibodies and an elevated level of the rheumatoid factor (RF). DIAGNOSES:She was diagnosed as papillary thyroid carcinoma. INTERVENTIONS:She had undergone thyroidectomy with lymph node dissection and radioactive therapy. OUTCOMES:She was found not to have recurrence despite a high serum Tg level. LESSONS:Our report illustrates a rare case of falsely elevated tumor markers levels due to assay interference caused by RF. This finding pointed out the importance of close communication between the clinician and laboratory staff in order to bring to light discordance between laboratory test results and clinical picture and avoid unnecessary diagnostic procedures and overtreatment.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Lupoli GA,Barba L,Liotti A,La Civita E,Lupoli R,Riccio E,Portella G,Formisano P,Beguinot F,Terracciano Ddoi
10.1097/MD.0000000000014178subject
Has Abstractpub_date
2019-02-01 00:00:00pages
e14178issue
5eissn
0025-7974issn
1536-5964pii
00005792-201902010-00019journal_volume
98pub_type
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