High-Dose Biotin Treatment for Secondary Progressive Multiple Sclerosis May Interfere with Thyroid Assays

Abstract

Objective To review cases and increase awareness in clinicians treating patients who may be taking biotin. Methods We describe the presentation and workup of a woman with secondary progressive multiple sclerosis on high dose biotin with laboratory studies suggestive of thyrotoxicosis. Results Plasma samples showed laboratory evidence of elevated thyroid hormone levels with elevated free thyroxine >7.8 ng/dl (reference interval (RI) 0.9-1.7 ng/dl) and decreased thyroid stimulating hormone <0.02 uIU/ml (RI 0.50-5.70 uIU/ml). Laboratory values normalized when biotin was withheld prior to repeat testing. Conclusions Our case report demonstrates that ingestion of high dose biotin in multiple sclerosis patients can cause interference with laboratory assessment of thyroid function. This interference causes laboratory values suggestive of thyrotoxicosis and can lead to unnecessary evaluation. Clinicians should be aware of the risk of laboratory interference in this patient demographic.

The effect of biotin interference on the results of blood hormone assays

“…Biotin in a single dose of 30 mg interferes with assays of fT4, fT3, and thyroglobulin (the analyser from Beckman Coulter), and the interference is maintained for up to 24 h [18]. Three days after discontinuation of biotin, levels of TSH, T4, fT4, and T3 were back to normal in a patient who had been administered 100 mg of biotin three times a day [19]. For children and neonates treated with biotin at doses of 15-20 mg/kg/day, TSH, fT4, and T3 levels were back to normal within 24-48 h of discontinuation of supplementation, and a false high titre of antibodies against the TSH receptor was maintained for up to seven days.…”

“…They refer to various age groups: from neonates to the elderly. The majority of them reported abnormal results of concentration of thyroid hormones (fT4, fT3) and TSH [17][18][19][20][21][22][23][24][25], but also of PTH, adrenocorticotropic hormone (ACTH), prolactin, testosterone, cortisol, and oestradiol [6,16,26]. The number of those reports were so high that in November 2017 the American Food and Drug Administration (FDA) issued a warning indicating possible interference of biotin with immunochemical assays.…”

Supplementation with Phycocyanobilin, Citrulline, Taurine, and Supranutritional Doses of Folic Acid and Biotin—Potential for Preventing or Slowing the Progression of Diabetic Complications

“…Children with biotin-responsive genetic disorders have taken 100 mg daily or more without evident adverse effects, and pilot trials with high-dose biotin in multiple sclerosis, employing 100 mg three times daily, have not been attended by important side effects aside from a low incidence of gastrointestinal discomfort that remits over time [209,210,211]. (However, clinicians should be aware that biotin doses of this magnitude can interfere with thyroid function tests, such that they incorrectly suggest hyperthyroidism [212]).…”

Biotina e interferenze nei metodi immunologici; problemi e opportunità

“…Gli esami di funzionalità tiroidea, eseguiti su due dei più diffusi analizzatori che impiegano il sistema streptavidina-biotina (Modular, Roche e Access, Beckman-Coulter) erano compatibili con ipertiroidismo anche se non coerenti con la clinica; 3 giorni di sospensione dell'assunzione di biotina hanno riportato i risultati di fT4, fT3, TSH e TRAb all'interno dell'intervallo di riferimento; • Minkovsky et al [39] hanno confermato che la somministrazione di 300 mg/die di biotina, come previsto da studi recenti [40], a 3 pazienti con sclerosi multipla ha portato a un quadro laboratoristico dei risultati di TSH e fT4 ottenuti con una metodica (Roche) che impiega il sistema biotina-streptavidina di ipertiroidismo; • Piketty et al [23] hanno curato la rassegna più completa sull'argomento e hanno valutato non solo gli ormoni ma anche i principali analizzatori interessati al problema e concludendo con proposte operative per gestire e, quando possibile, rimuovere le interferenze che interessano il sistema biotina-streptavidina; • Batista et al [41] riportano un caso di quadro laboratoristico di ipertiroidismo e di aumento di estrogeni associato a diminuzione di FSH, in cui le determinazioni erano state eseguite in parte con analizzatore Roche e in parte con analizzatore Ortho. La paziente assumeva 10 mg/die di biotina per un problema di perdita di capelli.…”