{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T03:16:44Z","timestamp":1794021404734,"version":"4.8.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Considering the inherent vulnerability of immunoassays for heterophilic interference and the potential of Rheumatoid Factor (RF) to act as a heterophile-like antibody, we conducted this study to investigate if RF leads to any such heterophilic interference in seropositive rheumatoid arthritis (RA) patients. The study was done on the TSH assay as it is a noncompetitive, double antibody sandwich assay, which is known to be vulnerable to heterophilic interference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this cross-sectional observational study, eighty-four consecutive newly diagnosed RF-positive RA patients underwent TSH, Free T4, and anti-TPO estimation using the chemiluminescence technique (CLIA) on Siemens Immulite 1000 platform. The samples were screened for TSH interference using four methods: 1) analysis on a different platform, 2) assessment of linearity using doubling dilutions, 3) polyethylene glycol (PEG) precipitation, and 4) addition of a commercial blocker.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Ten samples had a loss of linearity on serial dilution, indicating potential interference. After heterophile blocker treatment, five cases exhibited interference. One patient had diagnostic interpretation discordance on the second platform. No sample on PEG precipitation suggested the influence of antibodies. It is worth noting that even in cases where interference was suspected, the clinical interpretation was largely unaffected by the correction of TSH values based on mean dilution or measurement after heterophile blocker treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>RF can cause heterophilic interference in TSH immunoassays used commercially. However, in most cases, this interference does not affect clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijem.ijem_99_23","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T02:00:23Z","timestamp":1709085623000},"page":"29-34","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Heterophilic Interference of Rheumatoid Factor in TSH Immunometric Assay: A Cross-Sectional Observational Study"],"prefix":"10.4103","volume":"28","author":[{"given":"Shaikh N.","family":"Nayeemuddin","sequence":"first","affiliation":[{"name":"Department of Endocrinology, ESIC Medical College and Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Panigrahi","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Bhattacharjee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Medical College, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhankar","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"key":"R1-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0009-8981(02)00275-9","article-title":"Towards a better understanding of heterophile (and the like) antibody interference with modern immunoassays","volume":"325","author":"Levinson","year":"2002","journal-title":"Clin Chim Acta"},{"key":"R2-20240828","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0002-9343(91)80170-Q","article-title":"Artifactual elevation of thyroid-stimulating hormone","volume":"90","author":"Wood","year":"1991","journal-title":"Am J Med"},{"key":"R3-20240828","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1365-2265.1994.tb02563.x","article-title":"Multiple spuriously abnormal thyroid function indices due to heterophilic antibodies","volume":"41","author":"Fiad","year":"1994","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R4-20240828","first-page":"e27","article-title":"Falsely raised TSH levels due to human anti-mouse antibody interfering with thyrotropin assay [published correction appears in Postgrad Med J 2007 Mar;83 (977):186. Krishnan, SGS [corrected to Santhana Krishnan, SG]]","volume":"82","author":"Santhana Krishnan","year":"2006","journal-title":"Postgrad Med J"},{"key":"R5-20240828","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1089\/thy.2006.0149","article-title":"Falsely elevated thyroid hormone levels due to anti-sheep antibody interference in an automated electrochemiluminescent immunoassay","volume":"17","author":"Monchamp","year":"2007","journal-title":"Thyroid"},{"key":"R6-20240828","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1515\/CCLM.2007.064","article-title":"Efficacy of a new blocker against anti-ruthenium antibody interference in the Elecsys free triiodothyronine assay","volume":"45","author":"Sapin","year":"2007","journal-title":"Clin Chem Lab Med"},{"key":"R7-20240828","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1258\/acb.2008.008066","article-title":"Interference from heterophilic antibodies in seven current TSH assays","volume":"45","author":"Ross","year":"2008","journal-title":"Ann Clin Biochem"},{"key":"R8-20240828","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.2169\/internalmedicine.47.1496","article-title":"Heterophile antibody interference with thyroid assay","volume":"47","author":"Chin","year":"2008","journal-title":"Intern Med"},{"key":"R9-20240828","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.ejim.2007.05.009","article-title":"Interference in free thyroxine immunoassay","volume":"19","author":"Ghosh","year":"2008","journal-title":"Eur J Intern Med"},{"key":"R10-20240828","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1258\/acb.2008.008224","article-title":"A patient with pseudo-Addison's disease and falsely elevated thyroxine due to interference in serum cortisol and free thyroxine immunoassays by two different mechanisms","volume":"46","author":"Saleem","year":"2009","journal-title":"Ann Clin Biochem"},{"key":"R11-20240828","first-page":"1305","article-title":"TSH-assay interference:Still with us","volume":"58","author":"Verdickt","year":"2012","journal-title":"Clin Lab"},{"key":"R12-20240828","first-page":"391","article-title":"When lab tests lie \u2026heterophile antibodies","volume":"43","author":"Morton","year":"2014","journal-title":"Aust Fam Physician"},{"key":"R13-20240828","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.cca.2020.11.018","article-title":"Heterophilic antibody interference with TSH measurement on different immunoassay platforms","volume":"512","author":"Cheng","year":"2021","journal-title":"Clin Chim Acta"},{"key":"R14-20240828","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1210\/jc.2014-4023","article-title":"A case with immunoassay interferences in the measurement of multiple hormones","volume":"100","author":"Gulbahar","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"R15-20240828","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40842-015-0012-6","article-title":"Fulminant liver failure associated with delayed identification of thyroid storm due to heterophile antibodies","volume":"1","author":"Soleimanpour","year":"2015","journal-title":"Clin Diabetes Endocrinol"},{"key":"R16-20240828","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1002\/art.30213","article-title":"Erroneous augmentation of multiplex assay measurements in patients with rheumatoid arthritis due to heterophilic binding by serum rheumatoid factor","volume":"63","author":"Todd","year":"2011","journal-title":"Arthritis Rheum"},{"key":"R17-20240828","doi-asserted-by":"crossref","first-page":"4180","DOI":"10.4049\/jimmunol.140.12.4180","article-title":"Human monoclonal rheumatoid factor-like antibodies from CD5 (Leu-1)+B cells are polyreactive","volume":"140","author":"Nakamura","year":"1988","journal-title":"J Immunol"},{"key":"R18-20240828","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1084\/jem.168.6.1979","article-title":"Monoreactive high affinity and polyreactive low affinity rheumatoid factors are produced by CD5+B cells from patients with rheumatoid arthritis","volume":"168","author":"Burastero","year":"1988","journal-title":"J Exp Med"},{"key":"R19-20240828","doi-asserted-by":"crossref","first-page":"864907","DOI":"10.1155\/2012\/864907","article-title":"Autoimmune thyroid disease in rheumatoid arthritis:A global perspective","volume":"2012","author":"C\u00e1rdenas Rold\u00e1n","year":"2012","journal-title":"Arthritis"},{"key":"R20-20240828","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.beem.2013.05.011","article-title":"Heterophilic antibody interference in immunometric assays","volume":"27","author":"Bolstad","year":"2013","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"R21-20240828","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1210\/jc.2003-030122","article-title":"Phantoms in the assay tube:Heterophile antibody interferences in serum thyroglobulin assays","volume":"88","author":"Preissner","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"R22-20240828","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1515\/CCLM.2007.152","article-title":"On detecting interference from endogenous antibodies in immunoassays by doubling dilutions test","volume":"45","author":"Ismail","year":"2007","journal-title":"Clin Chem Lab Med"},{"key":"R23-20240828","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1373\/clinchem.2004.040501","article-title":"Prevalence of heterophilic antibody interference in eight automated tumor marker immunoassays","volume":"51","author":"Preissner","year":"2005","journal-title":"Clin Chem"},{"key":"R24-20240828","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1093\/clinchem\/48.11.2023","article-title":"Wrong biochemistry results:Two case reports and observational study in 5310 patients on potentially misleading thyroid-stimulating hormone and gonadotropin immunoassay results","volume":"48","author":"Ismail","year":"2002","journal-title":"Clin Chem"},{"key":"R25-20240828","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1177\/0004563213476271","article-title":"An immunoglobulin G complexed form of thyroid-stimulating hormone (macro thyroid-stimulating hormone) is a cause of elevated serum thyroid-stimulating hormone concentration","volume":"50","author":"Mills","year":"2013","journal-title":"Ann Clin Biochem"},{"key":"R26-20240828","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1515\/CCLM.2009.138","article-title":"Spuriously high thyrotropin values due to anti-thyrotropin antibodies in adult patients","volume":"47","author":"Verhoye","year":"2009","journal-title":"Clin Chem Lab Med"},{"key":"R27-20240828","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/cen.12643","article-title":"Macro TSH in patients with subclinical hypothyroidism","volume":"83","author":"Hattori","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"R28-20240828","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1089\/thy.2016.0442","article-title":"Anti-thyrotropin autoantibodies in patients with macro-thyrotropin and long-term changes in macro-thyrotropin and serum thyrotropin levels","volume":"27","author":"Hattori","year":"2017","journal-title":"Thyroid"},{"key":"R29-20240828","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1258\/acb.2008.007262","article-title":"Polyethylene glycol precipitation:Proceed with care","volume":"45","author":"Fahie-Wilson","year":"2008","journal-title":"Ann Clin Biochem"},{"key":"R30-20240828","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1007\/s00296-021-04865-9","article-title":"Rheumatoid factor and falsely elevated results in commercial immunoassays:Data from an early arthritis cohort","volume":"41","author":"Gehin","year":"2021","journal-title":"Rheumatol Int"},{"key":"R31-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/03009742.2016.1161070","article-title":"Multiplex cytokine analyses in patients with rheumatoid arthritis require use of agents blocking heterophilic antibody activity","volume":"46","author":"Olsson","year":"2017","journal-title":"Scand J Rheumatol"}],"container-title":["Indian Journal of Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijem.ijem_99_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:21:32Z","timestamp":1787768492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijem.ijem_99_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijem.ijem_99_23","relation":{},"ISSN":["2230-8210","2230-9500"],"issn-type":[{"value":"2230-8210","type":"print"},{"value":"2230-9500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-03-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}