Intake of high dose biotin: A cause of artificial hyperthyroidism

Introduction. - Many hormone immunoassays use the biotin streptavidin interaction to immobilize immune complexes. The intake of high dose biotin can interfere with immunoassays using the biotin streptavidin interaction. The biotin-immunoassay interference generates falsely low or falsely high tests of hormones according to the type of immunoassay used. Case report. - A 70-year-old patient, with progressive multiple sclerosis, was referred to our hospital for thyrotoxicosis. She was found to have markedly elevated thyroid hormones level (T3-T4) and decreased thyrotropin (TSH) level but she had no symptoms of hyperthyroidism. An ingestion of biotin, that is more and more frequent in patients with progressive multiple sclerosis, was found. Thyroid function tests normalized after discontinuation of biotin treatment. Conclusion. - The discrepancy between a clinical exam which is not indicative of thyrotoxicosis and markedly abnormal thyroid function tests should lead to a search for biotin intake, which can interfere with thyroid function tests. (C) 2019 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.