PEG Precipitation to Detect Macro-TSH in Clinical Practice: A Systematic Review

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2024-12-19 DOI:10.1111/cen.15179

Tommaso Piticchio, Isabella Chiardi, Andrea Tumminia, Francesco Frasca, Mario Rotondi, Pierpaolo Trimboli

{"title":"PEG Precipitation to Detect Macro-TSH in Clinical Practice: A Systematic Review","authors":"Tommaso Piticchio, Isabella Chiardi, Andrea Tumminia, Francesco Frasca, Mario Rotondi, Pierpaolo Trimboli","doi":"10.1111/cen.15179","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n <p>Macro-thyroid-stimulating hormone (macro-TSH) is a complex formed by monomeric TSH with anti-TSH antibodies, causing falsely elevated TSH levels and potential misdiagnosis of hypothyroidism. Identification of macro-TSH is essential for proper treatment and patient follow-up. Its diagnostic gold standard is gel filtration chromatography (GFC), which is very expensive, time-consuming, and rarely available. Polyethylene glycol (PEG) precipitation is more accessible and inexpensive. The aim of the study was to review evidence on PEG precipitation for the detection of macro-TSH to standardize its application in clinical practice.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>According to PRISMA guidelines, we conducted up to August 2024 a comprehensive search of PubMed and Scopus databases, using terms related to macro-TSH and PEG precipitation.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 23 studies with 4476 subjects, encompassing 10 observational studies and 13 case series/reports. All studies showed a low risk of bias. They were conducted in tertiary centres and included newborns to elderly subjects. The most of evidence about the procedure has been achieved with PEG concentrations of 12.5%. The PEG-precipitable TSH of the macro-TSH cases was always higher than 75% ranging on average from 81% to 90%. No-macro-TSH cases (controls) showed a PEG-precipitable TSH percentage ranging from 44.1% to 61.8%.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>PEG precipitation can be taken into account as a useful diagnostic tool for macro-TSH. However, it is necessary to perform PEG precipitation in cases with a highly suspicious clinical picture and at the same time perform all available ancillary tests. PEG-precipitable TSH > 75% can be considered a reliable diagnostic threshold for macro-TSH cases.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 3","pages":"235-244"},"PeriodicalIF":3.0000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15179","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen.15179","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Macro-thyroid-stimulating hormone (macro-TSH) is a complex formed by monomeric TSH with anti-TSH antibodies, causing falsely elevated TSH levels and potential misdiagnosis of hypothyroidism. Identification of macro-TSH is essential for proper treatment and patient follow-up. Its diagnostic gold standard is gel filtration chromatography (GFC), which is very expensive, time-consuming, and rarely available. Polyethylene glycol (PEG) precipitation is more accessible and inexpensive. The aim of the study was to review evidence on PEG precipitation for the detection of macro-TSH to standardize its application in clinical practice.

Methods

According to PRISMA guidelines, we conducted up to August 2024 a comprehensive search of PubMed and Scopus databases, using terms related to macro-TSH and PEG precipitation.

Results

We included 23 studies with 4476 subjects, encompassing 10 observational studies and 13 case series/reports. All studies showed a low risk of bias. They were conducted in tertiary centres and included newborns to elderly subjects. The most of evidence about the procedure has been achieved with PEG concentrations of 12.5%. The PEG-precipitable TSH of the macro-TSH cases was always higher than 75% ranging on average from 81% to 90%. No-macro-TSH cases (controls) showed a PEG-precipitable TSH percentage ranging from 44.1% to 61.8%.

Conclusions

PEG precipitation can be taken into account as a useful diagnostic tool for macro-TSH. However, it is necessary to perform PEG precipitation in cases with a highly suspicious clinical picture and at the same time perform all available ancillary tests. PEG-precipitable TSH > 75% can be considered a reliable diagnostic threshold for macro-TSH cases.

Abstract Image

查看原文本刊更多论文

聚乙二醇沉淀检测临床实践中的巨量tsh：系统综述。

大促甲状腺激素（macrothyroids -stimulating hormone, macro-TSH）是TSH单体与抗TSH抗体形成的复合物，可导致TSH水平错误升高，并可能误诊为甲状腺功能减退。确定大tsh是必要的适当治疗和患者随访。它的诊断金标准是凝胶过滤色谱法（GFC），这种方法非常昂贵、耗时，而且很少使用。聚乙二醇（PEG）沉淀法更容易获得，也更便宜。本研究的目的是回顾聚乙二醇沉淀法检测巨量tsh的证据，以规范其在临床实践中的应用。方法：根据PRISMA指南，我们对PubMed和Scopus数据库进行了截至2024年8月的全面检索，使用与宏观tsh和PEG沉淀相关的术语。结果：我们纳入了23项研究，4476名受试者，包括10项观察性研究和13例病例系列/报告。所有研究均显示偏倚风险较低。他们在三级中心进行，包括新生儿和老年人。大多数关于该程序的证据已经实现了PEG浓度为12.5%。宏观TSH病例的peg可沉淀TSH均高于75%，平均为81% ~ 90%。无宏观TSH病例（对照组）显示peg可沉淀TSH百分比范围为44.1%至61.8%。结论：聚乙二醇沉淀可作为一种有用的大tsh诊断工具。然而，在临床表现高度可疑的病例中，有必要进行聚乙二醇沉淀，同时进行所有可用的辅助检查。聚乙二醇可沉淀TSH bb0 75%可被认为是宏观TSH病例的可靠诊断阈值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.