Macro-TSH: Bir tanı zorluğu

Yıl 2024, Cilt: 46 Sayı: 6, 986 - 989, 07.11.2024

Özben Özden Işıklar , İlknur Elifoğlu Veysel Nijat Baş

https://doi.org/10.20515/otd.1475402

Öz

Macro-TSH, a rare laboratory interference, poses a diagnostic challenge, especially in pediatric patients. We present a case of a 5-year-old male patient with macroTSH, characterized by elevated thyroid-stimulating hormone (TSH) levels without symptoms of hypothyroidism. Despite normal free thyroxine (fT4) levels, the discrepancy between clinical findings and TSH levels prompted further investigation. Serum samples treated with polyethylene glycol (PEG) revealed a significant decrease in TSH levels, confirming the presence of macro-TSH. This case underscores the importance of clinical and laboratory findings in discordant TSH and fT4 levels. Recognition of macro-TSH can prevent unnecessary investigations and treatments, improving patient management

Anahtar Kelimeler

Thyroid Stimulating Hormone, False Positive Reaction, Pituitary Adenoma

Macro-TSH: A Diagnostic Dilemma

Öz

Macro-TSH, nadir görülen bir laboratuvar interferansı olup özellikle pediatrik hastalarda tanı açısından zorluklar oluşturur. Bu yazıda, hipotiroidizm belirtileri olmaksızın yüksek tiroid uyarıcı hormon (TSH) seviyeleriyle karakterize edilen makro-TSH’lı 5 yaşındaki bir erkek hastanın vakası sunulmaktadır. Normal serbest tiroksin (fT4) seviyelerine rağmen, klinik bulgular ile TSH seviyeleri arasındaki uyumsuzluk daha fazla araştırmayı gerektirmiştir. Polietilen glikol (PEG) ile işlenen serum örnekleri, TSH seviyelerinde belirgin bir azalma göstermiş ve makro-TSH varlığını doğrulamıştır. Bu vaka, TSH ve fT4 seviyeleri arasında uyumsuzluk olduğu durumlarda klinik ve laboratuvar bulgularının dikkatli bir şekilde değerlendirilmesinin önemini vurgulamaktadır. Makro-TSH'nin tanınması, gereksiz tetkik ve tedavilerin önlenmesine ve böylelikle hastaların yönetiminde iyileşmeye yol açabilir.

Anahtar Kelimeler

Thyroid Stimulating Hormone, False Positive Reaction, Pituitary Adenoma

Etik Beyan

Informed Consent: The authors declared that informed consent form was signed by the patient. Copyright Transfer Form: Copyright Transfer Form was signed by the authors. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Kaynakça

• 1. Loh TP, Kao SL, Halsall DJ, Toh SAES, Chan E, Ho SC, et al. Macro-thyrotropin: A case report and review of literature. J Clin Endocrinol Metab. 2012;97(6):1823–8.
• 2. Hande Peynirci, Canan Ersoy, Ahmet Sahin SI. Macro-TSH Can be a Rare Cause of Elevated Serum Thyroid Stimulating Hormone Concentration: A Case Report. Vol. Medicine S. 2014. p. 1691–6.
• 3. Sakai H, Fukuda G, Suzuki N, Watanabe C, Odawara M. Falsely elevated thyroid-stimulating hormone (TSH) level due to macro-TSH. Endocr J. 2009;56(3):435–40.
• 4. Rix M, Laurberg P, Porzig C, Kristensen SR. Elevated thyroid-stimulating hormone level in a euthyroid neonate caused by macro thyrotropin-IgG complex. Acta Paediatr Int J Paediatr. 2011;100(9):135–7.
• 5. Larsen CB, Petersen ERB, Overgaard M, Bonnema SJ. Macro-TSH: A Diagnostic Challenge. Eur Thyroid J. 2021;10(1):93–7.
• 6. Donadio-Andrei S, Hubert N, Raverot V, Plantin-Carrenard E, Kuczewski E, Charrié A, et al. A challenging case: Highly variable TSH in a mother and her two children. Clin Chem Lab Med. 2019;57(6):E114–7.
• 7. Nkuna X, Dire Z, Khoza S. A Macro-TSH: A Clinical Diagnostic Dilemma. EJIFCC. 2022 Dec 12;33(4):317-324. PMID: 36605299; PMCID: PMC9768619.
• 8. Fukushita, Miho, et al. "A case of macro-TSH consisting of IgA-bound TSH." Endocrine Journal 68.10 (2021): 1241-1246.
• 9. Shareef M, Nasrallah MP, AlArab N, Atweh LA, Zadeh C, Hourani R. Pituitary incidentalomas in paediatric population: Incidence and characteristics. Clin Endocrinol (Oxf). 2021;94(2):269–76.
• 10. Naoki Hattori, MD, PHD1, Takeshi Matsuda, PhD1, Kazuhisa Chihara, MD1, Junko Nishioka, MD, PhD2 SE, MD, PhD3, Akira Shimatsu, MD P. Macro-Thyroid Stimulating Hormone (TSH) in Children. J Endocr Soc. 2020;4