- A Case of Hashimotos Thyroiditis with Anti-Triiodothyronine Autoantibody.
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Yun Ey Chung, Jeong Hee Han, Seong Jin Lee, Won Ki Min, Ki Young Park, Kun Ku Park, Dae Hyunk Moon, Il Min Ahn
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J Korean Endocr Soc. 2001;16(2):245-251. Published online April 1, 2001
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- Autoantibodies against thyroid hormones can be detected in the sera of patients with both thyroidal and non-thyroidal disorders. These antibodies interfere with the radioimmunoassay of serum total and free thyroid hormone concentrations, resulting in a discrepancy between the measured hormone levels and clinical features. This can in turn lead to an erroneous diagnosis and patients may receive unnecessary treatment from physicians who are unaware of the presence of the autoantibodies. We experienced a woman having Hashimotos' thyroiditis with a spurious elevation of total T3 and free T3 values according to one-step analog-tracer radioimmunoassay who was had been treated as Graves' disease in past. Through the use of a polyethylene glycol precipitation method, she was subsequently revealed to have anti-triiodothyronine autoantibodies. We report this case with a review of related literature.
- A Case of Porphyria with Acute Pancreatitis.
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Seok Won Chung, Jeong Hee Han, Young Min Ju, Kwang Hee Yoon, Won Seok Yang, Sung Koo Lee, Sung Kkwan Hong, Eun MEE hAN, Byung Sik Kim, Ki Up Lee
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J Korean Endocr Soc. 2000;15(1):128-132. Published online January 1, 2001
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- The porphyrias are a group of disorders caused by deficiency in the enzymes of the heme biosynthetic pathway. Patients with porphyria may develop neurovisceral attacks which include severe abdominal pain, neuropsychiatric manifestations and potentially fatal respiratory paralysis. However, these patients may also have abdominal pain not due to porphyria itself, and in such case, careful evaluation is important. We report a case of acute pancreatitis with masquerading acute attack of porphyria, which made us difficult to make a correct diagnosis. A 29-year-old female, previously diagnosed to have hepatic porphyria, presented with acute abdominal pain, back pain and leg pain for 3 days. Serum amylase was normal and 24-hour urine -ALA and PBG showed increased levels. After intravenous infusion of glucose, symptoms were improved. From the 10th day of admission, she complained severe abdominal pain, and was found to have severe metabolic acidosis, shock, and signs of peritonitis on the 12th day of admission. Emergency exploration revealed edematous pancreas. Amylase and lipase levels in serum and ascites were found to be markedly elevated. After conservative management, her general condition gradually improved and serum amylase and lipase levels were normalized.
- A Case of Graves' Disease with Spuriously Elevsted TSH due to Interference of Heterophilin Actibodies.
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Jeong Hee Han, Sung Jin Lee, Young Rok Sin, Eun Ju Lee, Eun Sook Kim, Sang Wook Kim, Jin Yub Kim, Il Min Ahn
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J Korean Endocr Soc. 1999;14(1):160-164. Published online January 1, 2001
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- Thyroid-stimulating hormone (TSH) is the most sensitive marker reflecting thyroid function. TraditionaUy, TSH concentration was measured by the method of RadioImmunoAssay (RIA) with the detection limits around 1 to 2 mIU/L, which was unable to differentiate hyperthyroid status. Since 1980s, owing to the sensitive assay for TSH, immunoradiometric assay (IRMA), it has been possible to detect low concentration of TSH by 0.001 mlU/L. TSH is composed of two glycopeptide subunits, a-subunit and B-subunit. Monoclonal antibodies, directed against two different sites of the TSH peptides, are used in IRMA. One antibody is directed toward the specific B-subunit of TSH molecule and is used to extract it from serum, a second antibody labelled with a radioactive material is then attached to the separated TSH to form "sandwhich" molecule that can be measured. Generally, mouse monoclonal antibodies are used as capture and detection antibodies. Infrequently, when there is heterophilic antibody, i.e. human anti-mouse antibody (HAMA), TSH can be measured as spuriously elevated, since HAMA may form a link between the signal and capture molecules. We report a case of inappropriately elevated TSH concentration due to heterophilic antibody, later diagnosed as Graves disease. A 41-year-old woman visited our clinic with the chief complaints of hand tremor, hyperphagia, weight loss for 3 months. Two years earlier, she underwent total colectomy due to colon cancer and had treat on multiple chemotherapies. The results of thyroid function test shows that TSH was 0.77 mIU/L, free T was 7.1 ng/dL (0.8~1.9), free T was 11.3 pg/mL (0.2~5.5). Thyroid specific auto- antibody results were anti-Tg-Ab 21.3 m/mL(0 100), anti-TPO-Ab 87.9m/mL(0100), TBIAb 7.8% (-15/15). Thyroid scan showed that radioactiveiodine uptake was increased and thyroid gland wasenlarged diffusely. Because TSH level was elevated, further evaluations were performed to differentiate with TSH producing pituitary tumor and pituitary resistance to thyroid hormone. Sellar MRI was normal, TRH stimulation test showed flat response. Since spurious elevation of TSH is possible at the presence of hetrophilic antibody, we rechecked TSH concentration after adding mouse monoclonal antibody to the patients serum with result of TSH less than 0.05 mIU/L. She was able to be diagnosed as Graves disease, and started with methimazole. Three months later, thyroid function test showed that TSH was 10.5 mIU/L, free T4 was 1.0 ng/dL, free T3 was 4.0 pg/mL. TSH level after removal the effect of heterophilic antibody with mouse monoclonal antibody was 0.71 mIU/L. Neutropenia was developed 5 months after methimazole therapy, to stop antithyroid medication. With the plan of radioactive iodine therapy if she relapses, she is being followed with periodic thyroid function test. We report a case of Graves disease with spuriously elevated TSH due to the effect of heterophilic antibodies.
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