{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:04:42Z","timestamp":1792184682152,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Macro\u2010thyroid\u2010stimulating hormone (macro\u2010TSH) is a complex formed by monomeric TSH with anti\u2010TSH antibodies, causing falsely elevated TSH levels and potential misdiagnosis of hypothyroidism. Identification of macro\u2010TSH is essential for proper treatment and patient follow\u2010up. Its diagnostic gold standard is gel filtration chromatography (GFC), which is very expensive, time\u2010consuming, 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\u2010TSH to standardize its application in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>According to PRISMA guidelines, we conducted up to August 2024 a comprehensive search of PubMed and Scopus databases, using terms related to macro\u2010TSH and PEG precipitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats: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\u2010precipitable TSH of the macro\u2010TSH cases was always higher than 75% ranging on average from 81% to 90%. No\u2010macro\u2010TSH cases (controls) showed a PEG\u2010precipitable TSH percentage ranging from 44.1% to 61.8%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PEG precipitation can be taken into account as a useful diagnostic tool for macro\u2010TSH. 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\u2010precipitable TSH\u2009&gt;\u200975% can be considered a reliable diagnostic threshold for macro\u2010TSH cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.15179","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T01:50:15Z","timestamp":1734659415000},"page":"235-244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["PEG Precipitation to Detect Macro\u2010TSH in Clinical Practice: A Systematic Review"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0567-6494","authenticated-orcid":false,"given":"Tommaso","family":"Piticchio","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Endocrinology Section University of Catania Catania Italy"},{"name":"Department of Medicine and Surgery University of Enna \u201cKore\u201d Enna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Chiardi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery Humanitas University Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tumminia","sequence":"additional","affiliation":[{"name":"Endocrinology Section Garibaldi\u2010Nesima Hospital Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Frasca","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Endocrinology Section University of Catania Catania Italy"},{"name":"Endocrinology Section Garibaldi\u2010Nesima Hospital Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Rotondi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics University of Pavia Pavia Italy"},{"name":"Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors Istituti Clinici Scientifici Maugeri IRCCS Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Trimboli","sequence":"additional","affiliation":[{"name":"Clinic for Endocrinology and Diabetology Ente Ospedaliero Cantonale Bellinzona Switzerland"},{"name":"Faculty of Biomedical Sciences Universit\u00e0 della Svizzera Italiana Lugano Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0442"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00119"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0624"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12643"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004563213476271"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000356507"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9052"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2013.05.011"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241411699"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xfre.2023.05.005"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad681"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2022.0457"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ21-0021"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2016-0902"},{"key":"e_1_2_10_16_1","unstructured":"J. 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