Thyroid-stimulating hormone (TSH) is the most sensitive marker reflecting thyroid function. TraditionaUy, TSH concentration was measured by the method of RadioImmunoAssay (RIA) with the detection limits around 1 to 2 mIU/L, which was unable to differentiate hyperthyroid status. Since 1980s, owing to the sensitive assay for TSH, immunoradiometric assay (IRMA), it has been possible to detect low concentration of TSH by 0.001 mlU/L. TSH is composed of two glycopeptide subunits, a-subunit and B-subunit. Monoclonal antibodies, directed against two different sites of the TSH peptides, are used in IRMA. One antibody is directed toward the specific B-subunit of TSH molecule and is used to extract it from serum, a second antibody labelled with a radioactive material is then attached to the separated TSH to form "sandwhich" molecule that can be measured. Generally, mouse monoclonal antibodies are used as capture and detection antibodies. Infrequently, when there is heterophilic antibody, i.e. human anti-mouse antibody (HAMA), TSH can be measured as spuriously elevated, since HAMA may form a link between the signal and capture molecules. We report a case of inappropriately elevated TSH concentration due to heterophilic antibody, later diagnosed as Graves disease. A 41-year-old woman visited our clinic with the chief complaints of hand tremor, hyperphagia, weight loss for 3 months. Two years earlier, she underwent total colectomy due to colon cancer and had treat on multiple chemotherapies. The results of thyroid function test shows that TSH was 0.77 mIU/L, free T was 7.1 ng/dL (0.8~1.9), free T was 11.3 pg/mL (0.2~5.5). Thyroid specific auto- antibody results were anti-Tg-Ab 21.3 m/mL(0 100), anti-TPO-Ab 87.9m/mL(0100), TBIAb 7.8% (-15/15). Thyroid scan showed that radioactiveiodine uptake was increased and thyroid gland wasenlarged diffusely. Because TSH level was elevated, further evaluations were performed to differentiate with TSH producing pituitary tumor and pituitary resistance to thyroid hormone. Sellar MRI was normal, TRH stimulation test showed flat response. Since spurious elevation of TSH is possible at the presence of hetrophilic antibody, we rechecked TSH concentration after adding mouse monoclonal antibody to the patients serum with result of TSH less than 0.05 mIU/L. She was able to be diagnosed as Graves disease, and started with methimazole. Three months later, thyroid function test showed that TSH was 10.5 mIU/L, free T4 was 1.0 ng/dL, free T3 was 4.0 pg/mL. TSH level after removal the effect of heterophilic antibody with mouse monoclonal antibody was 0.71 mIU/L. Neutropenia was developed 5 months after methimazole therapy, to stop antithyroid medication. With the plan of radioactive iodine therapy if she relapses, she is being followed with periodic thyroid function test. We report a case of Graves disease with spuriously elevated TSH due to the effect of heterophilic antibodies.
Adult ; Animals ; Antibodies ; Antibodies, Monoclonal ; Colectomy ; Colonic Neoplasms ; Drug Therapy ; Female ; Graves Disease* ; Hand ; Humans ; Hyperphagia ; Immunoradiometric Assay ; Iodine ; Limit of Detection ; Magnetic Resonance Imaging ; Methimazole ; Mice ; Neutropenia ; Peptides ; Pituitary Neoplasms ; Radioimmunoassay ; Recurrence ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin ; Tremor ; Weight Loss

PURPOSE: This study was performed to evaluate three-dimensional positional change of the condyle using 3D CT after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. PATIENTS AND METHODS: Nine patients who underwent BSSRO for mandibular set-back in skeletal class III malocclusion without facial asymmetry were examined. Miniplates were used for the fixation after BSSRO. 3-D CT was taken before, immediately after, and 6 months after undergoing BSSRO. After creating 3D-CT images using V-works 4.0(TM) program, axial plane, coronal plane, < sagittal plane were configured. Three dimensional positional change, from each plane to the condyle, of the nine patients was measured before, immediately after, and 6 months after undergoing BSSRO. RESULTS: 1. The mean value of mandibular set-back for nine mandibular prognathism patients was 7.36 mm (+/- 2.42 mm). 2. In the axial view, condyle is rotated inward immediately after BSSRO (p < 0.05), comparing with preoperative but outward 6 months after BSSRO comparing with postoperative (p < 0.05). 3. In the axial view, condyle is moved laterally immediately after BSSRO (p < 0.05), comparing with preoperative but regressed 6 months after BSSRO comparing with preoperative (p < 0.05). 4. In the frontal < coronal view, there is changed immediately after and 6 months after BSSRO, comparing with preoperative but no statistical difference. CONCLUSION: These results indicate that three-dimensional positional change of the condyle in skeletal class III patients is observed lateral displacement < inward rotation immediate after BSSRO, but the condyle in 6 months after BSSRO tends to regress to preoperative position.
Displacement (Psychology) ; Facial Asymmetry ; Humans ; Malocclusion ; Mandibular Condyle ; Osteotomy, Sagittal Split Ramus ; Prognathism