Ahmad Verdah, Lubitz Sara
Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey.
AACE Clin Case Rep. 2025 Jan 7;11(2):131-133. doi: 10.1016/j.aace.2024.12.010. eCollection 2025 Mar-Apr.
Thyroglobulin and antithyroglobulin antibodies are used in the surveillance of differentiated thyroid carcinomas. In patients with differentiated thyroid carcinoma who require intravenous immunoglobulin for autoimmune or malignant conditions, surveillance of antithyroglobulin antibodies is challenging. We present a case of a patient with papillary thyroid carcinoma who showed fluctuating antithyroglobulin antibody levels while receiving intravenous immunoglobulin.
A 41-year-old woman underwent total thyroidectomy, central and left modified neck dissection, and radioactive iodine ablation for multifocal papillary thyroid carcinoma with features of oncocytic and warthin-like variant and metastasis to 1 of 28 left lateral and 1 of 10 central lymph nodes. Ten years later, she contracted COVID-19 and developed COVID-19-associated encephalopathy for which she received intravenous immunoglobulin for 7 months. Five months after intravenous immunoglobulin initiation, surveillance thyroglobulin was <0.8 ng/mL (liquid chromatography with mass spectrometry, <0.4 ng/mL) and antithyroglobulin antibodies increased from undetectable to 97 IU/mL (chemiluminescent immunoassay, ≤1 IU/mL). After the final intravenous immunoglobulin dose, antithyroglobulin antibody levels progressively decreased, reaching 1 IU/mL (chemiluminescent immunoassay, ≤1 IU/mL) 6 months posttreatment. Neck ultrasounds showed no evidence of disease recurrence.
Intravenous immunoglobulin can affect monitoring of patients with differentiated thyroid carcinomas due to passive transfer of pooled donor antibodies, including antithyroglobulin antibodies. Newly detectable antithyroglobulin antibodies in this patient were likely due to measured donor antithyroglobulin antibodies via intravenous immunoglobulin rather than cancer recurrence.
In patients with differentiated thyroid carcinomas receiving intravenous immunoglobulin, the presence of donor antithyroglobulin antibodies should be considered when antithyroglobulin antibodies are newly detectable.
甲状腺球蛋白和抗甲状腺球蛋白抗体用于分化型甲状腺癌的监测。对于因自身免疫或恶性疾病需要静脉注射免疫球蛋白的分化型甲状腺癌患者，抗甲状腺球蛋白抗体的监测具有挑战性。我们报告一例甲状腺乳头状癌患者，其在接受静脉注射免疫球蛋白期间抗甲状腺球蛋白抗体水平波动。
一名41岁女性因多灶性甲状腺乳头状癌接受了全甲状腺切除术、中央区和左侧改良颈淋巴结清扫术以及放射性碘消融术，该肿瘤具有嗜酸性细胞和沃辛样变异特征，并转移至28个左侧淋巴结中的1个和10个中央淋巴结中的1个。十年后，她感染了新冠病毒并发展为新冠病毒相关脑病，为此接受了7个月的静脉注射免疫球蛋白治疗。开始静脉注射免疫球蛋白五个月后，监测的甲状腺球蛋白<0.8 ng/mL（液相色谱-质谱法，<0.4 ng/mL），抗甲状腺球蛋白抗体从不可检测增加到97 IU/mL（化学发光免疫分析法，≤1 IU/mL）。在最后一剂静脉注射免疫球蛋白后，抗甲状腺球蛋白抗体水平逐渐下降，治疗后6个月降至1 IU/mL（化学发光免疫分析法，≤1 IU/mL）。颈部超声未显示疾病复发迹象。
静脉注射免疫球蛋白可因汇集的供体抗体（包括抗甲状腺球蛋白抗体）的被动转移而影响分化型甲状腺癌患者的监测。该患者新检测到的抗甲状腺球蛋白抗体可能是由于静脉注射免疫球蛋白中检测到供体抗甲状腺球蛋白抗体，而非癌症复发。
对于接受静脉注射免疫球蛋白的分化型甲状腺癌患者，当新检测到抗甲状腺球蛋白抗体时，应考虑供体抗甲状腺球蛋白抗体的存在。
