MacroTSH: still a big problem for clinicians and clinical biochemists: lessons from a case report

Raverot, Veronique; Metrat, Stéphanie; Perrin, Pauline; Abeillon, Juliette; Lasolle, Hélène

doi:10.1530/ETJ-24-0013

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MacroTSH: still a big problem for clinicians and clinical biochemists: lessons from a case report

case-report

Author(s): Véronique Raverot ¹ ^, , Stéphanie Metrat ¹ , Pauline Perrin ¹ , Juliette Abeillon ² , Hélène Lasolle ²

Publication date (Electronic): 09 May 2024

Journal: European Thyroid Journal

Publisher: Bioscientifica Ltd

Keywords: macroTSH, interference, immunoassays, thyroid function tests

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Abstract

MacroTSH still interferes with TSH assays. We present here a case report illustrating the difficulties that can arise in such conditions and attempt to discuss the steps involved in diagnosis.

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Most cited references 21

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Interferences With Thyroid Function Immunoassays: Clinical Implications and Detection Algorithm

Julien Favresse, Maria-Cristina Burlacu, Dominique Maiter … (2018)

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Determination of prolactin: the macroprolactin problem.

Michael Fahie-Wilson, Thomas P Smith (2013)

Serum prolactin is frequently measured when investigating patients with reproductive disorders and elevated concentrations are found in up to 17% of such cases. Clinical laboratories rely predominantly on automated analysers to quantify prolactin levels using sandwich immunometric methodologies. Though generally robust and reliable, such immunoassays are susceptible to interference from a high molecular mass prolactin/IgG autoantibody complex termed macroprolactin. While macroprolactin remains reactive to varying degrees in all prolactin immunoassays, it exhibits little if any biological activity in vivo and consequently its presence is considered clinically irrelevant. Macroprolactinaemia, defined as hyperprolactinaemia due to excess macroprolactin with normal concentrations of bioactive monomeric prolactin, may lead to misdiagnosis and mismanagement of hyperprolactinemic patients if not recognised. Current best practice recommends that all sera with elevated total prolactin concentrations are sub-fractionated using polyethylene glycol precipitation to provide a more meaningful clinical measurement of the bioactive monomeric prolactin content. Manufacturers of prolactin assays should strive to minimise interference from macroprolactin in their assays. Clinical laboratories should introduce screening procedures to exclude macroprolactinaemia in all patients identified as having hyperprolactinaemia. Clinicians should be aware of this potential diagnostic pit fall and insist on PEG screening of all hyperprolactinaemic sera.

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Variability in the detection of macro TSH in different immunoassay systems.

Naoki Hattori, Takashi Ishihara, Akira Shimatsu (2016)

Macro TSH is a large molecular-sized TSH that is mostly a complex of TSH and IgG. Patients with macro TSH have elevated serum TSH and normal free thyroxine levels, mimicking subclinical hypothyroidism. The aim of this study was to clarify the degree of cross-reactivity of macro TSH to different commercial immunoassay systems.