[Inappropriately undetectable thyroglobulin after exclusion of interference from thyroglobulin antibodies]

Ann Biol Clin (Paris). 2011 Nov-Dec;69(6):721-5. doi: 10.1684/abc.2011.0635.
[Article in French]

Abstract

Thyroglobuline (Tg) is a large molecule of high molecular weight mainly indicated in monitoring differentiated thyroid cancer (DTC), its measurement remains difficult. We report the case of a patient who underwent total thyroidectomy for a poorly differentiated thyroid insular carcinoma. Despite several (131)I treatments, a progressive elevation of serum Tg is observed. A control performed in another laboratory using an immunoradiometric assay (IRMA Cisbio) returns an undetectable value (< 0,2 mg/L). A new sample was simultaneously sent to different laboratories. Three nonisotopic immunometric assays showed high values of Tg while the IRMA assay, considered the gold standard, gave a result below the detection threshold. The absence of Tg antibodies and of anti-mouse antibodies was confirmed. The IRMA Kit manufacturer agreed to carry out an expertise. After changing their detection antibody, the presence of a high Tg was demonstrated, in agreement with non-isotopic techniques. The expertise conclusion was a lack of detection by the IRMA Tg assay. This incident was notified to AFSSAPS by the manufacturer.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aged
  • Autoantibodies / blood
  • Autoantibodies / isolation & purification*
  • Carcinoma / blood
  • Carcinoma / diagnosis
  • Carcinoma / immunology
  • Carcinoma / surgery
  • Diagnostic Errors
  • Diagnostic Techniques, Endocrine / standards
  • Humans
  • Immunoradiometric Assay / methods
  • Immunoradiometric Assay / standards
  • Limit of Detection
  • Male
  • Sensitivity and Specificity
  • Thyroglobulin / analysis
  • Thyroglobulin / blood*
  • Thyroglobulin / immunology*
  • Thyroid Neoplasms / blood
  • Thyroid Neoplasms / diagnosis
  • Thyroid Neoplasms / immunology
  • Thyroid Neoplasms / surgery
  • Thyroidectomy

Substances

  • Autoantibodies
  • anti-thyroglobulin
  • Thyroglobulin