Biotin Interference in Assays for Thyroid Hormones, Thyrotropin and Thyroglobulin

Abstract

Background: Biotin has been reported to interfere with several commonly used laboratory assays resulting in misleading values and possible erroneous diagnosis and treatment. This report describes a prospective study of possible biotin interference in thyroid-related laboratory assays, with a comparison of different commonly used assay platforms. Materials and Methods: Thirteen adult subjects (mean age 45 ± 13 years old) were administered biotin 10 mg/day for eight days. Blood specimens were collected at three time points on day 1 and on day 8 (baseline, two, and five hours after biotin ingestion). Thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroxine binding globulin (TBG), and thyroglobulin (Tg) levels were analyzed with four different platforms: Abbott Architect, Roche Cobas 6000, Siemens IMMULITE 2000, and liquid chromatography with tandem mass spectrometry (LC-MS/MS). TSH, fT3, fT4, TT3, and TT4 were measured with Abbott Architect and Roche Cobas 6000. fT3, fT4, TT3, and TT4 were also measured by LC-MS/MS. Tg was measured by Siemens IMMULITE 2000. TBG was assessed with Siemens IMMULITE 2000. Results: Significant changes in TSH, fT4, and TT3 measurements were observed after biotin exposure when the Roche Cobas 6000 platform was used. Biotin intake resulted in a falsely lower Tg level when measurements were performed with Siemens IMMULITE 2000. At the time points examined, maximal biotin interference was observed two hours after biotin exposure both on day 1 and day 8. Conclusions: A daily dose of 10 mg was shown to interfere with specific assays for TSH, fT4, TT3, and Tg. Physicians must be aware of the potential risk of erroneous test results in subjects taking biotin supplements. Altered test results for TSH and Tg can be particularly problematic in patients requiring careful titration of levothyroxine therapy such as those with thyroid cancer.

Keywords: TSH; TT3; biotin; fT4; hyperthyroidism; thyroglobulin.

FIG. 1.

Changes in Tg, TSH, fT4, and T3 levels after biotin ingestion. Normal reference range: Roche Cobas 6000: TSH 0.27–4.20 μIU/mL, fT3 2.0–4.4 pg/mL, TT3 80–180 ng/dL, fT4 0.93–1.7 ng/dL, TT4 4.5–12.5 μg/dL; Abbott Architect: TSH 0.4–4.2 μIU/mL, fT3 2.5–3.9 pg/mL, TT3 87–178 ng/dL, TT4 5–12.2 μg/dL, fT4 0.8–1.5 ng/dL; LC-MS/MS: fT3 1.8 7.6 pg/mL, TT3 62–202 ng/dL, fT4 1.18 2.88 ng/dL, TT4 4.6 12.9 μg/dL; Siemens IMMULITE 2000: Tg 1.6–60 ng/mL. fT4, free T4; LC-MS/MS, liquid chromatography with tandem mass spectrometry; fT3, free T3; T3, triiodothyronine; T4, thyroxine; Tg, thyroglobulin; TT4, total T4.

FIG. 2.

Correlation of biotin levels with TSH, T3, fT4, Tg. Normal reference range: Siemens IMMULITE 2000: Tg 1.6–60 ng/mL; Roche Cobas 6000: TSH 0.27–4.20 μIU/mL, TT3 80–180 ng/dL, fT4 0.93–1.7 ng/dL, TT4 4.5–12.5 μg/dL.

FIG. 3.

Mechanism of biotin interference in laboratory assays.