Odhaib Samih A, Mansour Abbas A, Haddad Nazar S
Diabetes and Adult Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, College of Medicine, University of Basrah, Basrah, IRQ.
Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, IRQ.
Cureus. 2019 May 23;11(5):e4727. doi: 10.7759/cureus.4727.
Biotin is widely available over the counter in different doses and is used medically in the management of hair and nail problems. Recent literature suggested the use of high doses of biotin for the treatment of progressive multiple sclerosis. We present four cases that show a misleading increase in thyroid function tests toward a false diagnosis of Grave's disease after the administration of 20-30 mg biotin for different periods. All the four cases are free of the signs and symptoms of hyperthyroidism, and all of their results returned to baseline values within 24-48 hours after biotin withdrawal. The assemblage of these cases, thyroid assay results, and biotin doses had occurred by chance, with no selection bias, and they represented all cases of biotin interference with thyroid assays in our center during this year. The first case is a 23-year-old female who was diagnosed with Grave's disease during a routine checkup after she ingested a prescribed 20 mg biotin per day for three months for excessive hair fall. The second case is a 19-year-old female with hair and nail problems associated with iron deficiency anemia. She administered a self-prescribed biotin dose of 20 mg a day for a month. She asked an endocrinologist's opinion about a recent increase in her thyroid function tests, with no signs of hyperthyroidism. The third case is a 45-year-old man with near-total thyroidectomy for retrosternal multinodular goiter with compressive symptoms. His usual levothyroxine dose had been decreased from 100 to 50 microgram per day, after which he felt unwell and gained four kilograms, with signs and symptoms of hypothyroidism. His investigations were consistent with hyperthyroidism while his signs were of hypothyroidism, which was illogical. He was administered 30 mg medically prescribed biotin for nail changes due to recently diagnosed psoriasis. The fourth case is that of one of the authors who volunteered to take 30 mg of biotin daily for one week. His initial investigations were in the normal range but changed within this period to be Grave's disease-like, with no signs or symptoms. In conclusion, the ingestion of 20 mg or more of biotin may lead to a clinically relevant thyroid assay interference. The clinicians must take this point in consideration before assessing the results of any thyroid function tests.
生物素在柜台可广泛买到，有不同剂量，在医学上用于治疗头发和指甲问题。最近的文献建议使用高剂量生物素治疗进行性多发性硬化症。我们报告4例，这些病例显示在服用20 - 30毫克生物素不同时间段后，甲状腺功能检查出现误导性升高，导致对格雷夫斯病的误诊。所有4例均无甲状腺功能亢进的体征和症状，且在停用生物素后24 - 48小时内所有结果均恢复至基线值。这些病例、甲状腺检测结果和生物素剂量的组合是偶然发生的，无选择偏倚，它们代表了今年我们中心所有生物素干扰甲状腺检测的病例。第一例是一名23岁女性，因脱发严重，按医嘱每天服用20毫克生物素三个月后，在常规体检时被诊断为格雷夫斯病。第二例是一名19岁女性，有与缺铁性贫血相关的头发和指甲问题。她自行每天服用20毫克生物素，持续了一个月。她就近期甲状腺功能检查升高但无甲状腺功能亢进体征的情况咨询了内分泌科医生的意见。第三例是一名45岁男性，因胸骨后多结节性甲状腺肿伴压迫症状接受了近全甲状腺切除术。他的左甲状腺素常规剂量从每天100微克降至50微克，此后他感觉不适且体重增加了4千克，有甲状腺功能减退的体征和症状。他的检查结果与甲状腺功能亢进一致，而体征却是甲状腺功能减退，这不合逻辑。因最近诊断为银屑病导致指甲改变，他按医嘱服用了30毫克生物素。第四例是本文作者之一，自愿每天服用30毫克生物素，持续一周。他最初的检查结果在正常范围内，但在此期间变为类似格雷夫斯病的结果，且无体征或症状。总之，摄入20毫克或更多生物素可能导致临床上相关的甲状腺检测干扰。临床医生在评估任何甲状腺功能检查结果之前必须考虑到这一点。
