If you’re prescribing (or taking) high dose biotin, it might be interfering with certain labs you’re ordering.
Findings from a new JAMA study and associated case report.
Really important for clinicians and/or those taking biotin. JAMA just released a small study today demonstrating that high dose supplemental biotin interferes (increasing or decreasing) with a number of common diagnostic assays that rely on biotinylation, including thyroid function, vitamin D, PSA and N-terminal pro-brain natriuretic peptide. Note that not every laboratory uses a biotinylation method for these assays. And most larger reference labs use multiple methods with assay details listed in the directory of services, so we can confirm what we’re ordering and change it accordingly if needed.
Regardless, it’s up to us to figure it out. Or perhaps easier: prescribe a biotin washout for a week prior to collection.
At this same JAMA link, you’ll see a case report on biotin-induced interference on a thyroid panel (TSH and free T3) in a Graves patient. This error could’ve spelled disaster, but fortunately the laboratory suspected possible biotin interference and contacted the provider (I’ve never had the experience of a lab contacting me about biotin interference, have you? Mayo was the reference lab). Retesting after biotin washout showed improvement of thyroid numbers.
A few thoughts:
I prescribe biotin commonly….I’m running a Boston Heart advanced lipid panel routinely now that includes an NT-proBNP. I’ve seen plenty of very low results and few modest elevations without any apparent cause. Are these patients on biotin? Is BH using a biotinylation assay? Literally, these are questions I’m asking myself as I type. Of course, I’m also ordering many thyroid panels, D, PSA. I’ll need to confirm what methods are used.
We used biotinylation at the laboratory in our IgG4 food test. (Genova likely still uses this method. It’s extremely reliable. If you are ordering IgG4, consider a washout period prior to running the assay).
Look forward to hearing your thoughts.
PS-read our top tips for lab testing is eosinophilic esophagitis (EoE)