Friday, 8 April 2016

If you are taking sneaky Biotin tell your doctor before they do blood tests

Barbesino G. Misdiagnosis of Graves' disease with apparent severe hyperthyroidism in a patient taking biotin megadoses. Thyroid. 2016 Apr 4. [Epub ahead of print]

BACKGROUND:Accurate immunoassays measuring minute quantities of hormones are the cornerstone of the practice of endocrinology. Despite tremendous advances in this field, novel pitfalls in these tests emerge from time to time. Oral biotin can interfere with immunoassays of several hormones. The purpose of this report is to relate an extreme case of such interference.
PATIENT FINDINGS: A patient with progressive multiple sclerosis was found to have extremely elevated free thyroxine (FT4), triiodothyronine (T3) and suppressed thyrotropin (TSH) levels. His TSH receptor binding inhibiting antibody (TBII) level was also elevated. This constellation of laboratory findings suggested a diagnosis of severe Graves' disease. All of the assays yielding abnormal results employed the biotin-streptavidin affinity in their design. The patient had no symptoms of hyperthyroidism and detailed review of his medications revealed intake of megadoses of biotin. Temporary discontinuation of biotin treatment resulted in complete resolution of the biochemical abnormalities.
CONCLUSIONS: Non-physiologic biotin supplementation may interfere with several immunoassays, including thyroid hormones, TSH, thyroglobulin (Tg) and TBII leading to erroneous diagnoses. Questioning for biotin intake should be part of the evaluation for patients undergoing endocrine tests. Interruption of biotin supplementation for at least 2 days prior to biotin-sensitive tests should be sufficient to avoid major misdiagnoses.

                             

High dose Biotin is currently being investigated for progressive MS. Whilst you don't have access to these experimental pills, for a few dollars you can buy enough low biotin content pills from the health food shop for a fraction of the cost. So whilst you may be rattling from taking so many pills, make sure you don't get your thyroid removed in the process.

In this study the person was doing just this and went for a blood test, but because the test uses a molecule called streptavidin that binds to biotin there was a false positive signal in their blood test. This said there was an over active thyroid. Your doctor will act on these results, so be warned. If you are taking biotin, you should tell your doctor if they are going to do blood tests and if you are a doctor and get usually high results maybe ask the question "Areyou taking biotin?" You should stop doing this before any blood test...why waste your and the neuros time. 

Biotin, also known as vitamin H, is a small molecule that is present in tiny amounts in all living cells and is critical for a number of biological processes. The valeric acid side chain of the biotin molecule can be used to attach biotin to other molecules. In the context of immunostaining and bomarker stuff, biotin is conjugated to antibodies or to the enzyme reporters used to detect target antigens.

The extraordinary affinity of avidin for biotin allows biotin-containing molecules in a complex mixture to be specifically bound to avidin.  It contains four identical subunits and binds one molecule of biotin; thus, a total of four biotin molecules can bind to a single avidin molecule. This is used in bioassays for detecting hormones.

18 comments:

  1. I have heard that some people stop taking biotin for a week or several days before their blood tests, then resume again after.

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    1. As you can see it suggests two days wash out

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    2. yes so only two days is needed then and not a week.

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  2. This crock is still being investigated?

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    1. Yep and more will be presented at the AAN, it does something to some people

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    2. Since my daily 800IU of vitamin D seems to be causing heart palpitations and severe fatigue now, I'm wary of half-cocked advice on overdosing on vitamins. Particularly one where deficiency is so rare.

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    3. Anon at 9.49pm - it is extremely unlikely that a measly 800 IU of Vit D is the cause of heart palpitations and severe fatigue. If you are on IFN Beta 1-A and taking loads of NSAIDS such as paracetamol and ibuprofen it is possible that the heart palpitations and fatigue may be caused by a folate deficiency from constant use of NSAIDS taken to counter-act the flue-like side effects of IFN - I've been there and done that and learnt the hard way about this problem! You'd be better off talking to your GP about causes other than the small amount of Vit D you are taking.

      Vit D deficiency is not "rare" - it's just that it's taking an awfully long time for a lot of doctors to actually catch up on and implement recommendations based on current research. Old recommendations are just that: old. If Team G recommends 5,000 IU a day for everyone, including people who don't have MS, then that's good enough for me, and that's what I take.

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    4. Heart palpitations stopped when I gave the vD a break. I don't do any MS DMTs at all, nor loads of NSAIDs. Appropriate vD dose depends on your blood level.

      http://www.vitamindcouncil.org/further-topics/i-tested-my-vitamin-d-level-what-do-my-results-mean/

      I was referring to biotin with regard to deficiency being rare.

      I don't swallow anything, figuratively or otherwise, without thinking for myself.

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  3. Graves disease diagnosis also requires a radioactive iodine uptake test. Was it done for this patient? Did it come back as positive for Graves? From what I understand, your TSH levels might indicate hyperthyroidism, but the radioactive iodine uptake test tells you the cause. Not all hyperthyroidism is because of Graves.

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  4. "However, I suspect that most people who have decided to self-administer high dose Biotin probably won't bother to look for such information. Common sense is remarkably uncommon, especially when people are desperate to find something to treat their MS, even if one of the drivers for their search is the nasty side effects and risks of approved MS drugs."

    Well said, I see this ALL THE TIME. People are quick to realize the more profound side effects of DMT's but when it comes to over the counter supplementation many sail right in doing literally no investigation of potential problems or mechanisms of action for that matter.

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    1. AnonymousSaturday, April 09, 2016 1:58:00 pm

      I am the Anonymous who wrote the comment that MS Unites has quoted from - not sure what happened to my original post but it must have been uploaded at some point for MS Unites to be able to quote from it. Given the relative ease with which people can obtain Biotin, and the reach of the internet for people to find out about it, the most pertinent point in the article above is "Questioning for biotin intake should be part of the evaluation for patients undergoing endocrine tests". Note that I am not promoting the use of high dose Biotin, but do believe that people should make adequate efforts to inform themselves of impacts that it may have should they choose to self-treat with it. One of the closed FB pages has close to 3,700 "members", so the number of people self-treating is not insignificant. My original comment was:

      "There is full information on medDay's website about the potential interference of high dose Biotin on blood tests, including a list of all of the tests it is known to potentially impact.
      http://medday-lab.com/
      http://medday-lab.com/sandwishAssays.html
      http://medday-lab.com/competitiveAssays.html
      If anybody considers self-administering Biotin in high doses then they should have the sense to do their homework properly and become informed about these things.

      To give credit where credit is due [MD says xxxxxxxx. I am guessing this is why your comment was taken down as you can guide people where to do this and it is a practise we can't condone] does include information about the potential for high dose Biotin to affect blood test results, and a direct link to the information on medDay's website.

      I note that in article above there is no mention of whether the patient was asked if they had ever been treated with one of the approved MS drugs which has secondary auto-immunity problems (such as Graves disease) as a possible post treatment outcome.

      However, I suspect that most people who have decided to self-administer high dose Biotin probably won't bother to look for such information. Common sense is remarkably uncommon, especially when people are desperate to find something to treat their MS, even if one of the drivers for their search is the nasty side effects and risks of approved MS drugs"

      MD here speaking to DrK he said this happened to him and one of his patients only a couple of weeks ago/

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    2. MD at 4.18pm
      Thank you for re-posting an edited version of my comment, and apologies if I unwittingly broke the "rules" - people will find that site anyway - it's not hard to do.

      I should also perhaps clarify one point in my re-uploaded comment - I wrote that "I am not promoting the use of high dose biotin" when I meant to say that "I am not promoting the use of self-administered high dose biotin".

      My intention with my original post was to draw attention to the fact that access to information on how high dose biotin can affect blood tests is available. I'm guessing that there are quite likely to be people who are self-treating and who follow this blog but may not have "involved" themselves with the site I originally mentioned, and that by posting the medDay links here it might help increase awareness of impacts of self-treatment which is not declared to treating clinicians.

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    3. Thanks I think this post maybe is a warning to clinicians to invstigate if they get spurious results

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  5. There have been trials for high-dose biotin and results were pretty amazing. My doctor, a multiple sclerosis specialist, highly recommended ot. Prescription is needed from well-qualified compounding pharmacies. This is not a crock.

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    1. "The results are pretty amazing". The results have not been properly published and based on abstracts the vast majority show no response so hardly amazing and am surprised that anyone would be recommending it.

      indicate that I can

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  6. Kippers. That's what I think. They cure everything, given enough time.

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  7. Note that Philip Kingsley's Tricho Complex tablets each contain
    BIOTIN 500µg (100% RDA). For the first three months you are recommended to take two a day. So if you are taking these supplements to improve your hair, let your doctor know before thyroid blood tests.

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