Biotin can affect immuno lab results

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Hey all

Wanted to share something I found out today that literally shocked me. I visited a new Endo with my daughter. It was her appt.

Both of us became "hyper" around the same time.  Fast forward, this nice new doc asked if she was taking supplements. We ran off the list of what we take and when we got to Biotin he stopped us. He told us, their lab uses a form of Biotin to test TSH levels. If there is Biotin in your system, you can very likely get a False Zero TSH. But all labs are different. He explained the method our lab uses and it's more than likely the Biotin supplement causing her low TSH reading. Mine, we're not sure but he was surprised I was put on Methimazole without being tested without Biotin in my system for at least a month. 

You can also get a false TRAB reading. (below)

I confirmed this on the Internet and found out different labs use somewhat different methods to test thyroid but to be sure, Biotin can affect TSH and sometimes T4.  It can flip flop according to your lab. I'll paste some below I found on Endocrine News.  

This could explain why I had the bad lethargy and depression on higher doses of Methimazole and finally tapered to 2.5 mg. I might not even need it. 

Many patients are taking megadoses of biotin that can cause falsely high and falsely low results in a variety of laboratory tests, including thyroid tests.

Patients are taking these supplements mainly to improve their hair, skin, and nails — and might not consider them medications to report on their list.

Biotin interference with lab tests could be causing misdiagnoses — and even mistreatment — in an unknown number of patients. [/pullout-wide]

Large amounts of biotin in a patient sample can interfere with this process. However, the effects can be confusing because, depending on the particular assay, biotin can skew the results to be either falsely high or falsely low. In the case of competitive immunoassays — usually used for low molecular weight targets (such as T4, T3, and cortisol) — biotin interference causes a falsely high result. In immunometric (sandwich) assays, it gives a falsely low result.

Other characteristics of the assay can also make a difference. For instance, a longer incubation time increases the opportunity for interference. Different assays for various analytes, even from the same manufacturer, can therefore vary in their susceptibility to biotin interference.

At the laboratory Mariash uses, the free T4 and total T3 assays use a biotin-streptavidin fluorescent detection system, so biotin can cause falsely elevated results, but the TSH and total T4 assays are not affected. In contrast, at Greenlee’s lab, biotin can lead to falsely low TSH results, but free T3 and free T4 tests are not affected. Biotin can also cause her lab’s assay for thyrotropin receptor antibodies (TRAb) to be falsely positive, which could lead to a misdiagnosis of Graves disease.So I'm not taking any Biotin and cutting out some of my other supplements and Methimazole until my next blood test on 10/19 and see what my readings are. 

It's worth speaking to your doctor about this, especially if you're not symptomatic like my daughter and myself.  I might be slightly hyper due to my nodule, or it could be a combination of nodule and Biotin making TSH even lower.

I wish I could post the source because there is a lot of interesting info on this issue of January 2016: Thyroid Month. Beware of Biotin. 

 

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10 Replies

  • Posted

    Clarify my post. Quoted was from the article. My comments were accidentally attached.

    "At the laboratory Mariash uses, the free T4 and total T3 assays use a biotin-streptavidin fluorescent detection system, so biotin can cause falsely elevated results, but the TSH and total T4 assays are not affected. In contrast, at Greenlee’s lab, biotin can lead to falsely low TSH results, but free T3 and free T4 tests are not affected. Biotin can also cause her lab’s assay for thyrotropin receptor antibodies (TRAb) to be falsely positive,

    which could lead to a misdiagnosis of Graves disease."  <end>

    So I'm not taking any Biotin and cutting out some of my other supplements and Methimazole until my next blood test on 10/19 and see what my readings are. 

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  • Posted

    Oh my God  Jay .....  you've been a busy girl   .... and all to our  advantage too...

    how astute you are .  firstly i hope you and your daughter are well  . i'm going to take time after my shower and breakfast to get into all that info you just posted .  thank

     you so much for taking all that time to allow us to benefit from your appointment Jay , it's very generous of you .... how kind 💐

    luv m x🌹

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    • Posted

      Hi Madge & Dan

      Oh no problem. You all were my first thought after the doc told me. I've received so much help from everyone on this forum, it's my pleasure to give back.

      I can't believe it took 3 different Endos for us to discover this info. It's one of the first questions they should ask. My second Endo even wanted me on a higher dose. 

      I'll keep you posted after my next bloods in October.

      Hoping everyone is staying well. xo 

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  • Posted

    Hi Jave, thanks for taking the time to share this information. How lucky to come across an endocrinologist who investigates and tries to make sense of the symptoms a patient reports.

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  • Posted

    Interesting biotin connection. Years ago after a car accident my weight went up two dress sizes in 6 months. I had several tests including thyroid but they were all negative. Visited doctor about mark on back which turned out to be pigmentation and when asked how I was, said I had lost about 10 kilograms of weight. Felt great. Advised to have thyroid test and told yesterday I have hyperthyroidism and if I don't take Carbimazole for rest of my life I could have heart problems. Wow! Never been ill (don't even get colds), eat well, feel energetic but have some hair thinning at front and so starting using supplements with biotin for hair thinning and weak nails about 2 months ago. I cam about this in a random sort of way and despite negative prognosis of doctor I will visit Hale Clinic for a naturopaths view before starting medication. Thanks to you I will mention that I take biotin.

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    • Posted

      Hi Mal

      Wow, sounds like me. I felt fine physically other than feeling faint at times and a blood test picked up low TSH but T's were normal. Strange thing was both my daughter and I tested almost zero TSH at the same time. We both take the same supplements, one of which is 10,000mcg Biotin. I attributed my faintness to the stress of my husband's illness and passing. But I do have nodules, so one could be slightly overactive but maybe not enough to warrant the meds, which after a while, started making me feel really sick. 

      Good luck to you! I hope your next results are good. Keep us posted please xo

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    • Posted

      Make ... I'm no expert .. I have Graves' disease ( hyper with antibodies )  I'm now in remission 

      And was helped greatly initially with Carbimazole ... but I've NEVER heard of anyone being  'on it for  the rest of their lives  '

      That's a very long time  ( I hope ) 

      I was on it for months and that's often how it is fur must golk .. some maybe 2 or 3 years I've also heard .. sounds like your Dr is like most and doesn't know his Thyroid very well !

      Why don't you post your blood results on here and let's have a look to see what they say about your condition and what should be done .. to help you .

      Get yourself a

      Printed copy of the results .. which belong to you ...

      Post al l numbers  on here including those in brackets which are your  labs  ranges ..

      And let's see ..

      Good luck 

      Mx🌹

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  • Posted

    I read about this also but had heard you only need to be off biotin for 4,5 days before testing since It's a water soluble b vitamin that doesn't stay in the body. 

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  • Posted

    Hi Martha

    My PCP will order the test so I don't have to wait til October. I want to wait long enough till the Methimazole is out of my system too. Plus my daughter has a bad head cold which could change results. UGH. So we'll wait about 3 weeks. Hard to wait!!  I have to admit, I'm tense as I'm not sure if I need the med or not and don't like being off it if I need it. 

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