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Gant Kanegusuku A, Araque KA, Nguyen H, et al. The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol. Ther Adv Endocrinol Metab. 2021;12:2042018821989240doi: 10.1177/2042018821989240.
Gant Kanegusuku, A., Araque, K. A., Nguyen, H., Wei, B., Hosseini, S., & Soldin, S. J. (2021). The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol. Therapeutic advances in endocrinology and metabolism, 122042018821989240. https://doi.org/10.1177/2042018821989240
Gant Kanegusuku, Anastasia, et al. "The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol." Therapeutic advances in endocrinology and metabolism vol. 12 (2021): 2042018821989240. doi: https://doi.org/10.1177/2042018821989240
Gant Kanegusuku A, Araque KA, Nguyen H, Wei B, Hosseini S, Soldin SJ. The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol. Ther Adv Endocrinol Metab. 2021 Jan 27;12:2042018821989240. doi: 10.1177/2042018821989240. eCollection 2021. PMID: 33552466; PMCID: PMC7844449.
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Ther Adv Endocrinol Metab. 2021 Jan 27;12:2042018821989240. doi: 10.1177/2042018821989240. eCollection 2021.

The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol.

Therapeutic advances in endocrinology and metabolism

Anastasia Gant Kanegusuku, Katherine A Araque, Hung Nguyen, Bin Wei, Saman Hosseini, Steven J Soldin

Affiliations

  1. Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
  2. Endocrinology Pituitary Institute, Pacific Neuroscience Institute, John Wayne Cancer Institute, Santa Monica, CA, USA.
  3. Department of Laboratory Medicine, Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Bethesda, MD 20892-0001, USA.

PMID: 33552466 PMCID: PMC7844449 DOI: 10.1177/2042018821989240

Abstract

BACKGROUND: Immunoassay (IA) measurements of thyroid hormones have previously given inaccurate results of triiodothyronine (T3), free triiodothyronine (FT3), and free thyroxine (FT4) when concentrations of TBG are low. We evaluate the hypothesis that abnormal concentrations of specific binding proteins (BPs) affect IA measurements and provide results which might misguide the diagnosis and treatment of patients. This study assesses IAs for the measurement of T3, FT3, and cortisol when levels of TBG and CBG are high or low. Comparisons are made between IA and LC-MS/MS.

METHODS: Serum or plasma samples with high (>95th percentile,

RESULTS: When TBG levels are <5th percentile, the differences between the IA and LC-MS/MS results for T3 and FT3 are statistically significant (T3,

CONCLUSION: Abnormal BP concentrations appear to affect the accuracy of IA measurements of T3, FT3, and cortisol. The population of patients with either high or low levels of BPs is significant. Our samples reflect that 65% of women aged between 15 and 49 years are taking oral contraceptives in the US, and thus have elevated levels of BPs. In this group, IA results for cortisol are falsely low. Our samples reflect that patients with protein losing diseases have low BP concentrations. Among a group with renal complications, IA measurements of T3 are overestimated, while those of FT3 are underestimated. Are the Food and Drug Administration and diagnostic companies adequately assessing the accuracy of IA tests?

© The Author(s), 2021.

Keywords: corticosteroid-binding globulin; cortisol; free triiodothyronine; immunoassay; mass spectrometry; thyroxine; thyroxine-binding globulin; triiodothyronine

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

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