Immunoglobulin Preparations Can Mislead Clinical Decision-Making in Follow-Up of Differentiated Thyroid Cancer |
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| Institution: | 1. From the CHRU-Nancy, Department of Clinical Pharmacology and Toxicology – Centre Régional de Pharmacovigilance de Lorraine, Nancy, France;2. Université de Lorraine, CHRU-Nancy, Department of Biochemistry, Nancy, France;3. Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France;4. Department of Neurology, Site de Vesoul, Groupe Hospitalier de la Haute Saône, Vesoul, France;5. Université de Lorraine, Inserm UMR_S 1116 - DCAC, Nancy, France.;2. From the Department of Neurosurgery and Pituitary Tumor Center. The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;3. Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China;4. Department of Neurosurgery/Neurooncology, Sun Yat-sen University Cancer Center. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine. No.651, Guangzhou, China;5. Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China;6. Department of Medical Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;7. Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.;1. From the Department of Endocrinology and Metabolism, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China;2. the Department of Health Statistics, Second Military Medical University, Shanghai, China;3. the Division of Ultrasonography, Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China;4. the Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.;1. School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China;2. School of Medical Instrument and food engineering, University of Shanghai for Science and Technology, Shanghai 200093, China;3. School of Chemical Engineering and Advanced Materials, Newcastle University, NE1 7RU, United Kingdom |
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| Abstract: | Objective: Intravenous and subcutaneous immunoglobulins are commonly used for immune substitution or as immune modulators in a variety of inflammatory and autoimmune disorders. Exogenous thyroid-specific thyroglobulin (Tg) antibodies present in the donor plasma may interfere with the interpretation of measurements of Tg autoantibodies (Tg-Abs) in the recipient’s plasma and potentially trigger an immune response in the recipient’s immune cells. Levels of antibodies causing bioassay interferences or those leading to clinically relevant changes in patient outcomes are not known. Tg is used as a biomarker in the long-term surveillance of patients with differentiated thyroid cancer (DTC) following total thyroidectomy and radioactive iodine ablation. However, the presence of Tg-Abs in the circulation interferes with Tg measurements. Assessment of levels of Tg-Abs is thus recommended as a part of standard follow-up of DTC together with Tg testing.Methods: To understand the potential mechanisms and pathophysiologic significance of possible interferences associated with administration immunoglobulin preparations and Tg measurement, we overview the current knowledge on interactions between Tg autoimmunity and immunoglobulin preparations and illustrate diagnostic challenges and perspectives for follow-up of patients with DTC treated with exogenous immunoglobulins.Results: In patients with DTC treated with immunoglobulin preparations, monitoring of thyroid cancer using Tg and Tg-Abs is challenging due to possible analytical interferences through passive transfer of exogenous antibodies from immunoglobulin preparations.Conclusion: Analytical interferences must be suspected when a discrepancy exists between clinical examination and diagnostic tests. Collaboration between endocrinologists, biologists, and pharmacologists is fundamental to avoid misdiagnosis and unnecessary medical or radiologic procedures.Abbreviations: CT = computed tomography; DTC = differentiated thyroid cancer; FNAB = fine-needle aspiration biopsy; HAb = heterophile antibody; IMA = immunometric assay; IVIg = intravenous immunoglobulin; RAI = radioactive iodine; RIA = radioimmunoassay; SCIg = subcutaneous immunoglobulin; Tg = thyroglobulin; Tg-Ab = thyroglobulin autoantibody; Tg-MS = thyroglobulin mass spectrometry; TPO-Ab = thyroid peroxidase autoantibody; TSHR-Ab = thyrotropin receptor autoantibody |
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