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Fake news? Biotin interference in thyroid immunoassays
Viktoria F Koehler1, Ulrike Mann2, Ayham Nassour3
1Medical Department IV, University Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
Summary
High-dose biotin use in multiple sclerosis (MS) can interfere with thyroid function tests (TFTs), leading to inaccurate results. Patients should pause biotin intake before lab tests to ensure accurate thyroid assessment.
Area of Science:
- Neurology
- Endocrinology
- Clinical Chemistry
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- High-dose biotin is being investigated for its potential therapeutic effects on MS-related disability.
- Thyroid function tests (TFTs) are crucial for assessing thyroid health.
Observation:
- A patient with MS on high-dose biotin presented with falsely elevated TFTs suggestive of Graves' disease.
- Clinical examination and thyroid sonography did not support the laboratory findings.
- The discrepancy was linked to biotin interference with streptavidin-based immunoassays.
Findings:
- High-dose biotin (300 mg/day) intake caused falsely high thyroid function test results in a patient with multiple sclerosis.
- Biotin interference with streptavidin-biotin immunoassays can lead to misdiagnosis of hyperthyroidism.
- Discontinuation of biotin for two weeks normalized the TFTs, resolving the biochemical discrepancy.
Implications:
- Healthcare providers should inquire about biotin supplementation in patients undergoing TFTs.
- Biotin intake can significantly interfere with the accuracy of common immunoassays.
- Recommendations include pausing biotin intake (2-5 days) or using alternative, non-biotin-dependent assays for reliable thyroid function assessment.
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