4/8/2023 0 Comments Disruptor a mess o trouble![]() 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.Grebe, MD, PhD, professor of laboratory medicine & pathology and co-director of the endocrine laboratory at the Mayo Clinic in Rochester, Minn. The problem is that almost all immunoassays today contain biotin because they rely on the biotin–streptavidin attraction to either anchor the assay’s antibodies to a capture surface or capture them once they have reacted with a patient sample, according to Stefan K. It is marketed over the Internet, and Mariash recently saw a television advertisement for it, so its popularity could continue to grow. But some patients, like the one Mariash treated, are taking milligram amounts, and might not consider it a medication, so not worth mentioning. That’s what a multivitamin such as Centrum Silver contains. It is a B vitamin, and the Institute of Medicine recommends a daily intake of 30 mcg. It is marketed under a number of names, including vitamin B7, vitamin H, and coenzyme R, and sometimes may be listed only as an unnamed supplement to improve hair and nails. Many people have begun taking biotin mainly in the belief that it is a key contributor to keratin, and therefore can improve hair, nails, and skin. We could be treating people for Graves’ disease who don’t have it, and that’s really scary,” Greenlee says. She probably doesn’t have any thyroid problem. A lot of her tests look like she has Graves’, but she is taking massive doses of biotin. “I saw somebody just yesterday who has had an extensive workup for hyperthyroidism. We could be treating people for Graves’ disease who don’t have it, and that’s really scary.” - Carol Greenlee, MD, endocrinologist, Grand Junction, Colo. ![]() A lot of her tests look like she has Graves, but she is taking massive doses of biotin. Mariash presented this case at the recent International Thyroid Congress because he has recently encountered several patients whose abnormal thyroid test results were caused by taking biotin and “most endocrinologists don’t know about this problem.”Ĭarol Greenlee, MD, an endocrinologist practicing in Grand Junction, Colo., concurs that she is encountering an increasing number of confounding lab results caused by patients taking large doses of biotin. The problem had nothing to do with the patient’s thyroid - the biotin was interfering with the tests. Her tests returned to normal when she stopped taking biotin. Yes, she replied, she had recently started taking 10 mg a day in hopes of improving her hair and nails. Mariash, MD, professor of clinical medicine at Indiana University in Indianapolis, where additional laboratory tests had inconsistent results: her free T4 and total T3 were elevated, but her total T4, T4 index, and TSH were normal.įortunately, Mariash could clear up the confusion by asking the patient a simple question: “Are you taking biotin?” The physician referred the patient to Cary N. The physician had been treating the patient’s hypothyroidism successfully with levothyroxine for some time, when suddenly her free T4 levels spiked despite a normal thyroid stimulating hormone (TSH) level. The thyroid test results made no sense, so the patient’s primary care physician sought help from an endocrinologist. More patients are taking the dietary supplement biotin, which could be throwing off a number of test results from thyroid cancer to Graves’ disease. ![]()
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