Government Medical College, Kerala University of Health Sciences (KUHS), Thiruvananthapuram, India.
Department of Endocrinology, Diabetes and Metabolism, UnityPoint Clinic, UnityPoint Health-Methodist Hospital, Peoria, IL, USA.
J Med Case Rep. 2023 Jun 28;17(1):266. doi: 10.1186/s13256-023-04002-z.
Biotin is a commonly used supplement for hair, nail, and skin. Recent literature suggests that high-dose biotin therapy for neurological diseases like Multiple sclerosis can interfere with lab results that use biotin/streptavidin immunoassay, called biotin interference. Biotin interference can affect thyroid lab results, giving biochemical hyperthyroidism.
Our patient, a 64-year-old white man with a known history of multiple sclerosis, presented with elevated free T3, free T4, and low TSH that resembled hyperthyroidism. He had no symptoms of hyperthyroidism except some fatigue and tachycardia on the first encounter. He was started on anti-thyroid medications. He was then re-evaluated since his lab results remained the same after two months of anti-thyroid medications. It was found that he was on biotin, 10000mcg/day, for his multiple sclerosis. Biotin was discontinued, and five days later his lab results returned to normal values.
The lack of knowledge of biotin use by patients can lead to misdiagnosis of patients' thyroid lab results and improper management. Awareness about biotin interference and abnormal thyroid lab values should be a priority among clinicians and the public. If the biotin is discontinued on time, such misdiagnosis can be avoided.
生物素是一种常用于头发、指甲和皮肤的补充剂。最近的文献表明，高剂量生物素疗法可用于治疗多发性硬化等神经系统疾病，但会干扰使用生物素/链霉亲和素免疫测定的实验室结果，这种现象被称为生物素干扰。生物素干扰会影响甲状腺实验室结果，导致生化性甲状腺功能亢进。
我们的患者是一位 64 岁白人男性，患有多发性硬化症。他的游离 T3、游离 T4 升高，TSH 降低，类似于甲状腺功能亢进症。除了首次就诊时出现疲劳和心动过速外，他没有任何甲状腺功能亢进的症状。他开始接受抗甲状腺药物治疗。两个月后，他的甲状腺功能仍未改善，于是再次就诊。发现他因多发性硬化症每天服用 10000mcg 的生物素。停用生物素后，五天后他的实验室结果恢复正常。
由于患者缺乏对生物素使用的了解，可能导致误诊患者的甲状腺实验室结果和不当管理。临床医生和公众应优先了解生物素干扰和异常甲状腺实验室值。如果及时停用生物素，这种误诊是可以避免的。
