title: HIGH-DOSE BIOTIN TREATMENT FOR SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS MAY INTERFERE WITH THYROID ASSAYS.
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) 0.9-1.7 ng/dl) and decreased thyroid stimulating hormone <0.02 uIU/ml (RI 0.50-5.70 uIU/ml). Laboratory values normalized when biotin was withheld prior to repeat testing.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Minkovsky
authors.affiliation: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Mark N
authors.initials: MN
authors.lastname: Lee
authors.affiliation: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Mitra
authors.initials: M
authors.lastname: Dowlatshahi
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Trevor E
authors.initials: TE
authors.lastname: Angell
authors.affiliation: Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Lilian S
authors.initials: LS
authors.lastname: Mahrokhian
authors.affiliation: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Athena K
authors.initials: AK
authors.lastname: Petrides
authors.affiliation: Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Stacy E F
authors.initials: SE
authors.lastname: Melanson
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Marqusee
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Whitney W
authors.initials: WW
authors.lastname: Woodmansee
keywords: High dose biotin; competitive immunoassay; interference; multiple sclerosis; thyrotoxicosis