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Pseudo-hyperthyroidism: Biotin interference in a case with renal failure.

M Demiral1, Z K Kiraz2, I O Alataş2

  • 1Balikesir Atatürk City Hospital - Pediatric Endocrinology, Balikesir, Eskisehir Osmangazi University - Eskisehir, Turkey.

Acta Endocrinologica (Bucharest, Romania : 2005)
|March 28, 2022
PubMed
Summary

Biotin supplementation can interfere with lab tests, causing inaccurate thyroid function results. Discontinuing biotin therapy resolved these false laboratory hyperthyroidism findings in a pediatric patient with renal failure.

Keywords:
biotin interferencepseudo-hyperthyroidismrenal failure

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Area of Science:

  • Clinical Chemistry
  • Endocrinology
  • Pediatrics

Background:

  • Biotin interference is a known issue in immunoassays, potentially leading to erroneous results.
  • Patients with renal failure may experience prolonged biotin interference due to impaired excretion.

Purpose of the Study:

  • To present a case of laboratory hyperthyroidism in a pediatric patient caused by biotin interference.
  • To highlight the diagnostic challenges and management of biotin interference in patients with renal failure.

Main Methods:

  • A seven-month-old male with renal failure presented with symptoms suggestive of metabolic disease.
  • Initial thyroid function tests showed high free T4, free T3, and low TSH, leading to a diagnosis of hyperthyroidism and initiation of anti-thyroid medication.
  • Upon discovering biotin supplementation for acidosis, biotin interference was suspected, and thyroid function was re-evaluated after discontinuation.

Main Results:

  • The patient exhibited laboratory hyperthyroidism (high fT4, fT3; low TSH) and metabolic acidosis with renal failure.
  • Thyroid function tests normalized 12 days after discontinuing biotin therapy.
  • This confirmed biotin interference as the cause of the abnormal thyroid hormone levels.

Conclusions:

  • Biotin interference can mimic or mask true thyroid dysfunction, especially in patients with renal impairment.
  • Careful consideration of biotin intake is crucial when interpreting immunoassay results, particularly in patients with renal failure.
  • Alternative testing methods or a prolonged washout period after biotin cessation is recommended for accurate diagnosis.