More patients are taking the dietary supplement biotin, which could be throwing off a number of test results from thyroid cancer to Graves’ disease. The thyroid test results made no sense, so the patient ’ mho elementary concern doctor sought avail from an endocrinologist. The doctor had been treating the patient ’ s hypothyroidism successfully with levothyroxine for some time, when on the spur of the moment her release T4 levels spiked despite a convention thyroid gland stimulating hormone ( TSH ) level. The doctor referred the affected role to Cary N. Mariash, MD, professor of clinical medicine at Indiana University in Indianapolis, where extra testing ground tests had inconsistent results : her detached T4 and sum T3 were elevated, but her total T4, T4 index, and TSH were normal. fortunately, Mariash could clear up the confusion by asking the patient a dim-witted question : “ Are you taking biotin ? ”

Yes, she replied, she had recently started taking 10 magnesium a day in hopes of improving her hair and nails. Her tests returned to normal when she stopped taking biotin. The problem had nothing to do with the patient ’ second thyroid — the biotin was interfering with the tests. Mariash presented this case at the late International Thyroid Congress because he has recently encountered several patients whose abnormal thyroid quiz results were caused by taking biotin and “ most endocrinologists don ’ thyroxine know about this problem. ” Carol Greenlee, MD, an endocrinologist practice in Grand Junction, Colo., agree that she is encountering an increasing number of confounding lab results caused by patients taking large doses of biotin .

“ I saw person fair yesterday who has had an extensive workup for hyperthyroidism. A lot of her tests look like she has Graves, but she is taking massive doses of biotin. She credibly doesn ’ t have any thyroid gland problem. We could be treating people for Graves ’ disease who don ’ t have it, and that ’ s very scary. ” — Carol Greenlee, MD, endocrinologist, Grand Junction, Colo .

“ I saw person good yesterday who has had an extensive workup for hyperthyroidism. A distribute of her tests look like she has Graves ’, but she is taking massive doses of biotin. She probably doesn ’ t have any thyroid trouble. We could be treating people for Graves ’ disease who don ’ t have it, and that ’ s actually chilling, ” Greenlee says. An Unregulated Supplement
Many people have begun taking biotin chiefly in the belief that it is a key contributor to keratin, and therefore can improve hair, nails, and skin. It is marketed under a number of names, including vitamin B7, vitamin H, and coenzyme R, and sometimes may be listed only as an nameless addendum to improve hair’s-breadth and nails. It is a B vitamin, and the Institute of Medicine recommends a daily consumption of 30 microgram. That ’ s what a multivitamin such as Centrum Silver contains. But some patients, like the one Mariash treated, are taking milligram amounts, and might not consider it a medicine, so not worth mentioning. It is marketed over the Internet, and Mariash recently saw a television ad for it, so its popularity could continue to grow. An Issue with Assays
The problem is that about all immunoassays today contain biotin because they rely on the biotin–streptavidin drawing card to either anchor the assay ’ sulfur antibodies to a capture surface or capture them once they have reacted with a affected role sample, according to Stefan K. Grebe, MD, PhD, professor of testing ground medicine & pathology and co-director of the hormone testing ground at the Mayo Clinic in Rochester, Minn. Biotin At A Glance

  • Many patients are taking megadoses of biotin that can cause falsely high and falsely low results in a variety of laboratory tests, including thyroid tests.
  • Patients are taking these supplements mainly to improve their hair, skin, and nails — and might not consider them medications to report on their list.
  • Biotin interference with lab tests could be causing misdiagnoses — and even mistreatment — in an unknown number of patients. [/pullout-wide]
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large amounts of biotin in a patient sample distribution can interfere with this process. however, the effects can be confusing because, depending on the particular assay, biotin can skew the results to be either falsely high or falsely humble. In the case of competitive immunoassays — normally used for low molecular weight targets ( such as T4, T3, and hydrocortisone ) — biotin interference causes a falsely high result. In immunometric ( sandwich ) assays, it gives a falsely low leave. early characteristics of the assay can besides make a remainder. For case, a longer incubation time increases the opportunity for interference. Different assays for diverse analytes, even from the like manufacturer, can therefore vary in their susceptibility to biotin hindrance. At the testing ground Mariash uses, the spare T4 and total T3 assays use a biotin-streptavidin fluorescent detection arrangement, thus biotin can cause falsely elevated railway results, but the TSH and sum T4 assays are not affected. In line, at Greenlee ’ s lab, biotin can lead to falsely low TSH results, but free T3 and free T4 tests are not affected. Biotin can besides cause her lab ’ s assay for thyrotropin sense organ antibodies ( TRAb ) to be falsely positive, which could lead to a misdiagnosis of Graves disease.

Mariash says that even though he suspected what was causing the questionable results, getting to the bottomland of the trouble was not easy : “ I had to make a set of telephone calls to our testing ground. ultimately a supervisor told me what platform they were using. then I called the test manufacturer to get extra details, and they gave me enough information to know what was going on. But of naturally, they don ’ deoxythymidine monophosphate give you every detail because some of it is proprietary. ” Mariash ’ s testing ground director was unaware that biotin could be a problem. Grebe says it may fall to the doctor ordering the test to be argus-eyed : “ When your lab results don ’ t make common sense in terms of the clinical picture, or in terms of the configuration of lab results you have received, you should constantly think first of an assay interference — one of which is biotin — before you think of very alien reasons for this to have happened, such as TSH-secreting pituitary tumors. ” Puzzling Tests and a Revelation
Greenlee had an model of these confusing results when a affected role was referred to be evaluated for a potential diagnosis of adrenal carcinoma. The patient had presented complain of fluid retentiveness and slant gain. Her face was red and she was growing haircloth on her confront while losing hair on top of her pass. Her hydrocortisone and testosterone test results were elevated off the charts. Her thyroid tests were besides confusing, with broken TSH but normal T4 and T3 .

“ When your lab results don ’ t make sense in terms of the clinical picture, or in terms of the configuration of lab results you have received, you should always think first of an assay intervention — one of which is biotin — before you think of truly alien reasons for this to have happened, such as TSH-secreting pituitary tumors. ” — Stefan K. Grebe, MD, PhD, professor, testing ground music & pathology ; co-director, endocrine gland lab, Mayo Clinic in Rochester, Minn .

A normal adrenal CT scan ruled out cancer. Greenlee asked the woman to come back the next dawn for fasting blood tests. This meter her tests were normal. Greenlee thought that possibly there was some confusion at the lab, and the original tests were not this patient ’ second. The solution to the mystery only emerged over clock time. The patient ’ south problems stemmed from her home remedies for her hair loss — minoxidil and biotin. not knowing her haircloth loss was not unusual for an older woman, and despite warnings that it should not be used by women, she was putting minoxidil on the top of her head — resulting in a red, hairy front. The concluding part of the perplex fell into place when Greenlee was preparing a talk and came across a reference book to biotin interfering with a parathyroid gland hormone try. Her inquiry following up this clue led her to literature reports of early biotin interferences. In the case of this patient, because she had been told to fast before she was tested again, she had not taken biotin, so those results reflected her true condition. The biotin interference contributed to her out-of-kilter hydrocortisone, testosterone, and TSH results. In unraveling the mystery, Greenlee consulted with Grebe to learn more about the ins and outs of immunoassays and worked closely with her lab — making them aware of the potential intervention. Biotin Vigilance
Greenlee is nowadays making sure her practice identifies any patients taking the addendum : “ We have huge signs in my position that ask people if they are taking biotin — in each examination room, over the venesection chair, and at the front desk. We had all these nice pictures on our walls, but the biotin thing alarmed us thus much that we don ’ triiodothyronine manage about our decorations in our function anymore. ” “ It can be dangerous not to recognize it, ” Mariash agrees. He besides notes that clinicians need to be argus-eyed because laboratories can change the trial platform without notice. For the interference to occur, the patient ’ sulfur biotin level needs to be high — at least three times the upper limit of the goodly pornographic address scope, according to Grebe. But that level is easy to achieve with the megadoses many are taking. Grebe suggests that a clinician can ask the lab to try using another manufacturer ’ south screen, but an easier path is to ask the patient to stop the biotin then get retested. Biotin is urine soluble, so it washes out of the consistency quickly — evening a unmarried day can make a big difference in the test results.

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And although literature reports largely focus on problems with parathyroid gland and thyroid hormone tests, biotin intervention could be considered as a potential subscriber to about any leery immunoassay result. Published by the Endocrine Society, Endocrine News is a monthly publication that offers an in-depth look at endocrinology trends and research, from generative issues to biotin concerns to thyroid problems. When you ’ rhenium looking for the latest studies, interviews and comment on endocrinology, you can find it on our web site. With that in judgment, if you ’ re concern in reading extra contented with seasonably, accurate information on thyroid issues, check out our other articles such as “ Fairytales : Dispelling Pediatric Thyroid Cancer Myths ” and “ Thyroid Cancer and Radioiodine. ” Seaborg is a freelance writer based in Charlottesville, Va. He wrote about expanding the definition of osteoporosis in the December issue.

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