Macro-TSH Can Be a Rare Cause of Elevated Serum Thyroid Stimulating Hormone Concentration: A Case Report
Hande Peynirci, Canan Ersoy, Ahmet Sahin, Sazi Imamoglu.
Abstract
In this case report, an 18 years old female subject with incidentally detected thyroid stimulating hormon (TSH) elevation due to macro-TSH without clinical findings of thyroid disorder was defined. Initially, the laboratory investigations revealed high TSH [11.45 µIU/mL; normal reference interval (NRI: 0.50-5.50 µIU/mL)] with electrochemiluminescence immunoassay (ECLIA) method. When L-thyroxine and L-triodothyronine treatments were found to be ineffective for lowering TSH, polyethylene glycol (PEG) method for TSH measurement was planned to rule out the posibility of macro-TSH. TSH level upon using the PEG method was found to be within normal ranges as 1.96 µIU/mL. In conclusion, normal free thyroxine level accompanied by elevated TSH is mostly encountered in cases of subclinical hypothyroidism. Such a laboratory finding can also be caused by macro-TSH which is a rare condition. To avoid unnecessary investigations and treatment, macro-TSH should be kept in mind in patients with high TSH levels without symptoms of hypothyroidism in the differential diagnosis.
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