Annals of Clinical Biochemistry > Volume 45, Number 3 > Pp. 325-327

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Case Reports

Thyrotoxicosis factitia masquerading as recurrent Graves' disease: endogenous antibody immunoassay interference, a pitfall for the unwary

V R Jahagirdar^1,2, P Strouhal³, G Holder⁴, R Gama^2,5 and B M Singh¹

¹ Department of Diabetes and Endocrinology; ² Department of Clinical Chemistry; ³ Department of Radiology, New Cross Hospital, Wolverhampton WV10 0QP, UK; ⁴ Department of Clinical Biochemistry, University Hospital Birmingham, Birmingham B29 6JB, UK; ⁵ Research Institute, Wolverhampton University, West Midlands WY1 1SB, UK

Corresponding author: Prof R Gama, Department of Clinical Chemistry, New Cross Hospital, Wolverhampton WV10 0QP, UK. Email: rousseau.gama{at}rwh-tr.nhs.uk

Antibody interference in immunoassays is an underestimated problem, which has the potential to cause patient harm and waste health-care resources. We report a case where thyroglobulin antibodies generated a false-positive thyroglobulin result delaying the diagnosis of thyrotoxicosis factitia masquerading as recurrent Graves' disease. A high index of clinical suspicion and good laboratory-clinician communication underpins effective clinical and laboratory strategies to detect potentially erroneous laboratory results due to endogenous antibody interference in immunoassays.

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