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Immunoglobulin preparations can mislead clinical decision-making in follow-up of differentiated thyroid cancer

Endocrine Practice, 26(9), pp. 1031-1038.

Yéléhé-Okouma, M., Malaplate, C., Petipain, N., Metallo, M., Ziegler f, , Klein, M., Guerci, B., Feigerlova, E.

2020

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 antibodies present in the donor plasma may interfere with the interpretation of measurements of autoantibodies to thyroglobulin in the recipient's plasma and potentially trigger immune response in recipient's immune cells. Levels of antibodies causing bioassay interferences or those leading to clinically relevant changes in patient-outcomes are not known. Thyroglobulin is used as a biomarker in the long-term surveillance of patients with differentiated thyroid cancer, following total thyroidectomy and radioactive iodine ablation. However, presence of autoantibodies to thyroglobulin in the circulation interferes with thyroglobulin measurements. Assessment of levels of autoantibodies to thyroglobulin is thus recommended as a part of standard follow-up of differentiated thyroid cancer together with thyroglobulin testing. To understand the potential mechanisms and pathophysiological significance of possible interferences associated with administration immunoglobulin preparations and thyroglobulin measurement, we overview here the current knowledge on interactions between thyroglobulin autoimmunity and immunoglobulin preparations, and illustrate diagnostic challenges and the perspectives for follow-up of patients with differentiated thyroid cancer treated with exogenous immunoglobulins from the point of view of an endocrinologist, a biologist, and a pharmacologist.

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