Cargando…
Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report
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...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380811/ https://www.ncbi.nlm.nih.gov/pubmed/30702570 http://dx.doi.org/10.1097/MD.0000000000014178 |
_version_ | 1783396367620636672 |
---|---|
author | Lupoli, Gelsy Arianna Barba, Livia Liotti, Antonietta La Civita, Evelina Lupoli, Roberta Riccio, Enrico Portella, Giuseppe Formisano, Pietro Beguinot, Francesco Terracciano, Daniela |
author_facet | Lupoli, Gelsy Arianna Barba, Livia Liotti, Antonietta La Civita, Evelina Lupoli, Roberta Riccio, Enrico Portella, Giuseppe Formisano, Pietro Beguinot, Francesco Terracciano, Daniela |
author_sort | Lupoli, Gelsy Arianna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6380811 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-63808112019-03-04 Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report Lupoli, Gelsy Arianna Barba, Livia Liotti, Antonietta La Civita, Evelina Lupoli, Roberta Riccio, Enrico Portella, Giuseppe Formisano, Pietro Beguinot, Francesco Terracciano, Daniela Medicine (Baltimore) Research Article 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. Wolters Kluwer Health 2019-02-01 /pmc/articles/PMC6380811/ /pubmed/30702570 http://dx.doi.org/10.1097/MD.0000000000014178 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Research Article Lupoli, Gelsy Arianna Barba, Livia Liotti, Antonietta La Civita, Evelina Lupoli, Roberta Riccio, Enrico Portella, Giuseppe Formisano, Pietro Beguinot, Francesco Terracciano, Daniela Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title | Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title_full | Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title_fullStr | Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title_full_unstemmed | Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title_short | Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: A case report |
title_sort | falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma: a case report |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380811/ https://www.ncbi.nlm.nih.gov/pubmed/30702570 http://dx.doi.org/10.1097/MD.0000000000014178 |
work_keys_str_mv | AT lupoligelsyarianna falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT barbalivia falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT liottiantonietta falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT lacivitaevelina falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT lupoliroberta falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT riccioenrico falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT portellagiuseppe falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT formisanopietro falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT beguinotfrancesco falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport AT terraccianodaniela falselyelevatedthyroglobulinandcalcitoninduetorheumatoidfactorinnonrelapsingthyroidcarcinomaacasereport |