Misdiagnosis of Graves’ hyperthyroidism due to therapeutic biotin intervention

Roeck, Y De; Philipse, Eva; Twickler, Theodorus B; Gaal, Luc Van

doi:10.1080/17843286.2017.1396676

Cited by 12 publications

(7 citation statements)

References 5 publications

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“…Comparing TSH results detected on the old and new generation Elecsys TSH kit can be used as a new method to identify biotin interference. Previous reports showed that biotin can cause low TSH and lead to the wrong diagnosis of hyperthyroidism [15][16][17]. In our case, however, biotin caused high TSH level, contrary to previous reports.…”

Section: Discussioncontrasting

confidence: 99%

Interference Due to Heterophilic Antibody, Biotin and Thyroid Hormone Autoantibody

Ni¹,

Yu²,

li³

et al. 2021

Preprint

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Purpose: Immunoassay is susceptible to interference by other substances in the serum. The main substances interfering with thyroid function testing include heterophilic antibody, biotin, thyroid hormone autoantibody, and Macro-TSH. We reported a patient with fraudulently elevated FT4 and TSH and described various common experimental methods used to explore the existence of substances interfering with thyroid function testing.Methods and Results: FT4 and TSH were significantly lower when measured on the Architect platform (FT4: 7.09 pmol/L, TSH: 58.94 µIU/ml). Polyethylene glycol precipitation showed lower FT4 and TSH, suggesting the presence of a high molecular weight interfering substance. Heterophile blocking tube study showed heterophilic antibody interfered with TSH detection. 125I-hTSH binding study and radioimmunoprecipitation assay indicated that the patient didn’t contain anti-TSH autoantibody. The new generation of Elecsys immunoassay kit indicated that biotin interfered with TSH detection. Radioimmunoprecipitation assay showed that all four kinds of thyroid hormone autoantibodies were positive. After reviewing 24 literatures, we provided the diagnostic strategy for investigation of interferences with thyroid function immunoassays.Conclusion: We reported a case with falsely elevated TSH due to the combined action of heterophilic antibody and biotin and fraudulently elevated FT4 caused by thyroid hormone autoantibody. When there is a discrepancy between thyroid function and clinical manifestation, the presence of immunoassay interference with one or more indicators needs to be considered.

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Section: Discussioncontrasting

confidence: 99%

Interference Due to Heterophilic Antibody, Biotin and Thyroid Hormone Autoantibody

Ni¹,

Yu²,

li³

et al. 2021

Preprint

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“…To our knowledge, there are currently no reports on the interference of biotin with radioiodine uptake scans. Interestingly, our patient had mild symptoms consistent with hyperthyroidism while most patients with thyrotoxicosis due to biotin interference presented with minimal or no symptoms [4, 7, 8].…”

Section: Discussionmentioning

confidence: 88%

“…This immobilization system produces false positive results on standardized thyroid panel laboratory values. Lab results showing thyrotoxicosis in asymptomatic patients taking biotin have been reported in multiple cases [4]. However, results of radioactive iodine uptake (RAIU) scan while a patient is taking biotin are not well reported.…”

Section: Introductionmentioning

confidence: 99%

Aberrant Thyroid Function Tests in a Patient Taking Biotin Supplements

Latif

Crupie

2019

Cureus

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Biotin is a component of the B-complex vitamins that has been widely used in over-thecounter supplements. The effects of biotin on thyroid function tests (TFTs) have been recently reported by multiple authors. We report here a case of a patient who presented with TFTs consistent with hyperthyroidism and a positive radioactive iodine uptake (RAIU) scan while taking biotin supplements. The TFTs normalized almost a month later and continued to be normal even after resumption of biotin supplements. Interpreting TFTs while patients are taking biotin could pose a diagnostic challenge, so we suggest more frequent monitoring for those patients before starting them on long-term anti-thyroid medications.

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“…As luminescent label most often are used tris (2,2′-bipyridyl) ruthenium (II). Often, such analytical systems contain avidin-biotin reagents based on the capture ELISA principle and have a quite satisfactory bioanalytical characteristic, which brings opportunities for their wide practical use (De Roeck et al, 2017;Nie et al, 2017;Wang et al, 2017b).…”

Section: Methods For Detecting Of Systems Based On Mpsmentioning

confidence: 99%

Modern magnetic immunoassay: Biophysical and biochemical aspects

Galkin

Besarab

Pysmenna

et al. 2017

Regul. Mech. Biosyst.

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In this review article an analysis of the biochemical and biophysical aspects of modern magnetic immunoassay (MIA) is conducted and additionally the problems and perspectives of its application in biology, biotechnology and medicine are defined. Magnetic immunoassay should be considered as an evolutionary extension of the classical immunoassay. MIA can have many variants of modifications, similar to the classic immunoenzymatic assay. The key distinctive element of the MIA is the use of magnetic particles (MPs), which are usually nanoparticles. MPs in the MIA can act as a marker for detection, or the solid phase at which the immunochemical reaction takes place. MIA possesses basic advantages over classical immunoassay methods: thanks to the unique magnetic properties of the MPs and the ability to manipulate it in the external magnetic field, it is possible to increase the informative value of the analysis (first of all, sensitivity and specificity), as well as the rigid requirements for “purity” of tested samples. For the purposes of immunoassay, magnetic particles of size from 10 to 200 nm are important, since such particles are in a superparamagnetic state, in the absence of strong magnetic fields; they are not agglomerated in a liquid medium. The size of the spherical particle determines the rate of sedimentation and mobility in the solution. The outer polymeric membrane serves as a matrix in which the surface functional groups are added, and also protects the core of the metal from the external environment. The outer shell may also consist of agarose, cellulose, porous glass, silicon dioxide etc. There are several strategies for the synthesis of nanoparticles: mechanical (dispersion), physical (gas phase deposition), wet chemical methods (chemical comprecipitation, thermal decomposition, methods of micro emulsion, hydrothermal reactions) and physico-chemical methods. Also used are magnesite nanoparticles of biogenic origin. Magnetic particles may function, and this is important for immunoassay. Surface functional groups include carboxylic, amino, epoxy, hydroxyl, tosyl, and N-hydroxysuccinate-activated groups. Magnetic spherical particles usually interact with surface molecules such as streptovidine, biotin, protein A, protein G, and immunoglobulin etc. Directions and prospects of the development of methods of magnetic immunoassay are determined, mainly, by the development of methods for detecting or influencing magnetic particles. In this case, the classical methods of detection are electrochemical methods, electrochemiluminescence, fluorescence. More modern ones include giant magnetoresistance, superconducting quantum interference devices, surface-enhanced Raman spectroscopy, biosensors based on nonlinear magnetization, magneto-PCR immunoassay. The current trend is to combine or integrate the application of various biochemical, physical, molecular and genetic, physico-chemical detection methods. In fact, all of these benefits undoubtedly open up broad prospects for the practical application of MIA in biology, biotechnology and medicine.

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Misdiagnosis of Graves’ hyperthyroidism due to therapeutic biotin intervention

Cited by 12 publications

References 5 publications

Interference Due to Heterophilic Antibody, Biotin and Thyroid Hormone Autoantibody

Interference Due to Heterophilic Antibody, Biotin and Thyroid Hormone Autoantibody

Aberrant Thyroid Function Tests in a Patient Taking Biotin Supplements

Modern magnetic immunoassay: Biophysical and biochemical aspects

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