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Biotin induced biochemical hyperthyroidism: a case report and review of the literature.

  • 2023-06-28
  • Journal of medical case reports 17(1)
    • Archa James
    • Jinu Stalan
    • Jose Kuzhively

Study Design

Type
Review
Population
a 64-year-old white man with a known history of multiple sclerosis
Methods
presented with elevated free T3, free T4, and low TSH; started on anti-thyroid medications; found to be on biotin, 10000mcg/day, for his multiple sclerosis; biotin discontinued
Duration
two months

Background

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.

Case presentation

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.

Conclusion

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.

Research Insights

  • Vitamin B7→Increased Thyroid Hormone Level

    He was on biotin, 10000mcg/day, for his multiple sclerosis. Biotin was discontinued, and five days later his lab results returned to normal values.

    Effect
    Harmful
    Effect size
    Moderate
    Dose
    10000mcg/day
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