High-Dose Biotin Treatment for Secondary Progressive Multiple Sclerosis May Interfere with Thyroid Assays

Alissa Minkovsky, MD, PhD; Mark N. Lee, MD, PhD; Mitra Dowlatshahi; Trevor E. Angell, MD; Lilian S. Mahrokhian, MD; Athena K. Petrides, PhD; Stacy E.F. Melanson, MD, PhD; Ellen Marqusee, MD; Whitney W. Woodmansee, MD

AACE Clinical Case Reports (Jan 2016)

High-Dose Biotin Treatment for Secondary Progressive Multiple Sclerosis May Interfere with Thyroid Assays

Alissa Minkovsky, MD, PhD,
Mark N. Lee, MD, PhD,
Mitra Dowlatshahi,
Trevor E. Angell, MD,
Lilian S. Mahrokhian, MD,
Athena K. Petrides, PhD,
Stacy E.F. Melanson, MD, PhD,
Ellen Marqusee, MD,
Whitney W. Woodmansee, MD

Affiliations

Alissa Minkovsky, MD, PhD: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Mark N. Lee, MD, PhD: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Mitra Dowlatshahi: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Trevor E. Angell, MD: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Lilian S. Mahrokhian, MD: Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Athena K. Petrides, PhD: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Stacy E.F. Melanson, MD, PhD: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Ellen Marqusee, MD: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Whitney W. Woodmansee, MD: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.; Address correspondence to Dr. Whitney W. Woodmansee, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA. E-mail:

Journal volume & issue: Vol. 2, no. 4
pp. e370 – e373

Abstract

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ABSTRACT: Objective: To review cases and increase awareness in clinicians treating patients who may be taking biotin.Methods: We describe the presentation and workup of a woman with secondary progressive multiple sclerosis on high-dose biotin, with laboratory studies suggestive of thyrotoxicosis.Results: Plasma samples showed laboratory evidence of elevated thyroid hormone levels, with elevated free thyroxine >7.8 ng/dL (reference interval [RI], 0.9 to 1.7 ng/dL) and decreased thyroid-stimulating hormone <0.02 μIU/mL (RI, 0.5 to 5.7 μIU/mL). Laboratory values normalized when biotin was withheld prior to repeat testing.Conclusion: Our case report demonstrates that ingestion of high-dose biotin in multiple sclerosis patients can cause interference with laboratory assessment of thyroid function. This interference causes laboratory values suggestive of thyrotoxicosis and can lead to unnecessary evaluation. Clinicians should be aware of the risk of laboratory interference in this patient demographic.Abbreviations: MS = multiple sclerosis; TSH = thyroid-stimulating hormone; T3 = triiodothyronine; T4 = thyroxine

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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