Ardabilygazir Arash, Afshariyamchlou Sonia, Mir Danial, Sachmechi Issac
Medicine, Icahn School of Medicine at Mount Sinai Queen Hospital Center, New York, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai Queen Hospital Center, New York, USA.
Cureus. 2018 Jun 20;10(6):e2845. doi: 10.7759/cureus.2845.
Biotin is a readily available supplement that is part of the B-complex vitamins. It is an essential co-factor for five carboxylases involved in fatty acid synthesis and energy production. The recommended daily intake (RDI) of biotin ranges from 30 to 70 mcg per day. At high doses (10,000 times RDI), biotin improves clinical outcomes and quality of life in patients with progressive multiple sclerosis (MS). It has been reported to cause interference in immunoassays resulting in abnormal thyroid function tests. Hereby we are describing the case of a patient having MS who was on high-dose biotin, seen in the clinic for a follow-up visit with thyroid function tests suggestive of Graves' disease with no signs and symptoms of hyperthyroidism and completely normal physical examination. In the case we have described, the laboratory measurements suggestive of thyrotoxicosis were attributed to interference of the patient's high-dose biotin treatment with the biotin-streptavidin chemistry of the immunoassays. We observed normalization of the thyroid stimulating hormone (TSH) and free T4 measurements when the patient withheld biotin for a week. As our case illustrates, early consideration of biotin interference minimizes unnecessary repeat laboratory studies. As trials in MS are progressing, we expect to see more patients on high-dose biotin treatment with spurious laboratory measurements. Therefore, we advise careful history taking and close communication with the laboratory when the clinical picture does not match with the laboratory results.
生物素是一种易于获取的补充剂，是复合维生素B的一部分。它是参与脂肪酸合成和能量产生的五种羧化酶的必需辅助因子。生物素的推荐每日摄入量（RDI）为每天30至70微克。在高剂量（RDI的10000倍）时，生物素可改善进行性多发性硬化症（MS）患者的临床结局和生活质量。据报道，它会干扰免疫测定，导致甲状腺功能测试异常。在此，我们描述了一名患有MS且正在服用高剂量生物素的患者的病例，该患者在诊所进行随访时，甲状腺功能测试提示患有格雷夫斯病，但无甲状腺功能亢进的体征和症状，体格检查完全正常。在我们描述的病例中，提示甲状腺毒症的实验室测量结果归因于患者高剂量生物素治疗对免疫测定中生物素-链霉亲和素化学的干扰。当患者停用生物素一周时，我们观察到促甲状腺激素（TSH）和游离T4测量值恢复正常。正如我们的病例所示，早期考虑生物素干扰可减少不必要的重复实验室检查。随着MS试验的进展，我们预计会看到更多接受高剂量生物素治疗的患者出现虚假的实验室测量结果。因此，当临床情况与实验室结果不匹配时，我们建议仔细询问病史并与实验室密切沟通。
