Lundin Michael S, Alratroot Ahmad, Abu Rous Fawzi, Aldasouqi Saleh
Internal Medicine, Michigan State University, East Lansing, Michigan, USA
Sparrow Hospital, Lansing, Michigan, USA.
BMJ Case Rep. 2020 Mar 31;13(3):e231337. doi: 10.1136/bcr-2019-231337.
A 69-year-old woman with a remote history of Graves' disease treated with radioactive iodine ablation, who was maintained on a stable dose of levothyroxine for 15 years, presented with abnormal and fluctuating thyroid function tests which were confusing. After extensive evaluation, no diagnosis could be made, and it became difficult to optimise the levothyroxine dose, until we became aware of the recently recognised biotin-induced lab interference. It was then noticed that her medication list included biotin 10 mg two times per day. After holding the biotin and repeating the thyroid function tests, the labs made more sense, and the patient was easily made euthyroid with appropriate dose adjustment. We also investigated our own laboratory, and identified the thyroid labs that are performed with biotin-containing assays and developed strategies to increase the awareness about this lab artefact in our clinics.
一名69岁女性，有格雷夫斯病病史，曾接受放射性碘消融治疗，服用稳定剂量左甲状腺素15年，现甲状腺功能检查结果异常且波动，令人困惑。经过广泛评估，仍无法做出诊断，且难以优化左甲状腺素剂量，直到我们意识到最近认识到的生物素诱导的实验室干扰。随后发现她的用药清单包括每天两次服用10毫克生物素。停用生物素并重复甲状腺功能检查后，检查结果更合理，通过适当调整剂量，患者很容易达到甲状腺功能正常状态。我们还对自己的实验室进行了调查，确定了使用含生物素检测方法进行的甲状腺检查项目，并制定了提高临床对这种实验室假象认识的策略。
