False hyperthyroidism caused by interference in immunoassays

OBJECTIVES: Immunoassays used to assess thyroid function are vulnerable to different types of interference that may affect clinical decision-making. CASE PRESENTATION: We report the case of a 37-year-old woman who developed iatrogenic hypothyroidism after having received radioiode therapy who visited our hospital for her annual checkup. The patient was asymptomatic, without signs suggestive of thyroid disease. However, laboratory analysis proved otherwise: thyrotropin (TSH) 7.75 mU/L, thyroxine (FT4) >7.7 ng/dL. CONCLUSIONS: The inconsistency between her clinical symptoms and the biochemistry data raised the possibility of a methodological interference. A thorough evaluation of the main causes of interference was conducted in the laboratory to exclude the presence of interference in TSH and FT4. Finally, different interfering agents were identified, which affected free thyroid hormone and TSH determination.