Interferences with thyroid function immunoassays: clinical implications and detection algorithm.
(2018) Endocrine Reviews — Vol. 39, n° 5, p. 830-850 (2018)
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- Current automated immunoassays used to evaluate thyroid function are vulnerable to different types of interference that can impact clinical decision. This review provides a detailed overview of the six main interferences affecting measurements of thyroid-stimulating hormone, free thyroxine and free triiodothyronine, namely macroTSH, biotin, anti-streptavidin antibodies, anti-ruthenium antibodies, thyroid hormone autoantibodies, and heterophilic antibodies. As the prevalence of some of these conditions has been reported to approach 1% and the frequency of testing for thyroid dysfunction is important, the scale of the problem might therefore be tremendous.Potential interferences in thyroid function testing should always be suspected whenever clinical or biochemical discrepancies arise. Their identification usually relies on additional laboratory tests that include assay method comparison, dilution procedures, blocking reagents studies, and polyethylene glycol precipitation. Based on the pattern of thyroid function test alterations, we propose a detection algorithm to screen for the six above-mentioned interferences.The review also aims at evaluating the clinical impact of thyroid interference on immunoassays, which has not been widely studied so far. Through the revision of reported data from more than 150 subjects, we found that at least 50% of documented thyroid interferences led to misdiagnosis and/or inappropriate management of the patients, including prescription of an unnecessary treatment (with side effects in some situations), inappropriate suppression or modification of an ongoing treatment, or utilization of unnecessary complementary tests such as I123 thyroid scan. We finally wish to emphasize the need for a strong interaction between the clinician and the laboratory to avoid such pitfalls.
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Favresse, J., Burlacu, M. C., Maiter, D., & Gruson, D. (2018). Interferences with thyroid function immunoassays: clinical implications and detection algorithm. Endocrine Reviews, 39(5), 830-850. https://doi.org/10.1210/er.2018-00119 (Original work published 2018)