Diagnostic Dilemma in Discordant Thyroid Function Tests Due to Thyroid Hormone Autoantibodies.

OBJECTIVE: Assay interference could be the cause of abnormal thyroid function tests. Early recognition prevents inappropriate patient management. The objective of this report is to present a case with discordant thyroid function tests in different thyroid assay platforms due to thyroid autoantibodies. METHODS: We present a case her family, laboratory data and methods that investigate immunoassay interference. RESULTS: A 21-year-old woman with autoimmune thyroid disease was treated for hypothyroidism with levothyroxine and noted to have elevated total and free thyroxine, free triiodothyronine but normal thyroid-stimulating hormone. Repeat thyroid function tests using different platforms revealed discrepant results. Further investigation showed that the patient had positive thyroid hormone autoantibodies (THAAbs). CONCLUSION: We demonstrates abnormal thyroid function tests caused by THAAbs. The latter were the cause of interference with assays resulting in discrepant test results inconsistent with the clinical presentation. Early recognition would prevent inappropriate patient management.

IL12RB2 gene is associated with the age of type 1 diabetes onset in Croatian family Trios.

BACKGROUND: Common complex diseases are influenced by both genetic and environmental factors. Many genetic factors overlap between various autoimmune diseases. The aim of the present study is to determine whether four genetic variants known to be risk variants for several autoimmune diseases could be associated with an increased susceptibility to type 1 diabetes mellitus. METHODS AND FINDINGS: We genotyped four genetic variants (rs2358817, rs1049550, rs6679356, rs9865818) within VTCN1, ANXA11, IL12RB2 and LPP genes respectively, in 265 T1DM family trios in Croatian population. We did not detect association of these polymorphisms with T1DM. However, quantitative transmission disequilibrium test (QTDT, orthogonal model) revealed a significant association between the age of onset of T1DM and IL12RB2 rs6679356 variant. An earlier onset of T1DM was associated with the rs6679356 minor dominant allele C (p = 0.005). The association remained significant even after the Bonferroni correction for multiple testing and permutation. CONCLUSIONS: Variants originally associated with juvenile idiopathic arthritis (VTCN1 gene), sarcoidosis (ANXA11 gene), primary biliary cirrhosis (IL12RB2 gene) and celiac disease (LPP gene) were not associated with type 1 diabetes in our dataset. Nevertheless, association of IL12RB2 rs6679356 polymorphism with the age of T1DM onset suggests that this gene plays a role in defining the time of disease onset.

Glycosyltransferase B4GALNT1 and type 1 diabetes in Croatian population: clinical investigation.

OBJECTIVES: Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by destruction of pancreatic beta cells. Gangliosides are thought to be a target of a variety of anti-islet autoantibodies. The formation of gangliosides is catalyzed by addition of sugar residues to complex glycoconjugate molecules by glycosyltransferases. Beta-1,4-N-acetyl-galactosaminyl transferase 1 is the enzyme involved in the synthesis of asialo, a, b and c-series gangliosides and it is coded by B4GALNT1 gene. DESIGN AND METHODS: We genotyped 2 B4GALNT1 tagSNPs, designed to capture 100% of common variation in the region, in 202 families and 199 controls from the Croatian population. RESULTS: Transmission disequilibrium test and case-control analysis did not detect an association of B4GALNT1 gene with T1DM. CONCLUSIONS: Expression of gangliosides requires coordinated work of many genes. There is enough evidence showing that gangliosides are plausible contributors to T1DM pathological processes and, therefore, future studies on different glycosyltransferase genes are necessary.