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BLOG: Serious harm may arise from unreported biotin use
Part 2 of a prior post about safety concerns with the over-the-counter supplement.
Picture this scenario:
Me: Please notify patient that her thyroid labs are not adding up. To my knowledge she is not on any thyroid-related medication, and she has just had neck exploration with parathyroid gland removal? She was not hyperthyroid at her office visit on Monday, and thyroid-stimulating hormone is not suppressed? The most plausible explanation is biotin effects on laboratory tests, so please inquire if the patient is taking biotin in any form — supplements, liquid shakes, nutritional boosts, mutlivitamins, hair-nail-skin products, any form whatsoever?
Nurse: I spoke with that patient. She confirmed that she is taking biotin supplements.
Me: Please have her stop biotin and repeat thyroid labs when she is off Biotin.
The above was excerpted from my clinic’s EMR from last week. The dialogue was a communication that continues in our clinic: Patients are still not reporting to our nurses, physicians or other providers that they are taking biotin, nor do we remember to ask. Thus, biotin is still not included on the medication list of these patients’ EMR records.
This is despite the continuous public education I have been disseminating most of last year through presenting case reports at local and national meetings and discussing the problem on TV news.
At our annual regional endocrine symposium in mid-Michigan, the Annual David Rovner Endocrine Symposium (ADRES), we dedicated a lecture to discussing biotin effects on thyroid labs.
Another example is this recent interview that I gave to our local station (WILX, News Channel 10), just a few weeks ago.
Despite all of that, some of my patients are still taking biotin without disclosing that during clinic visits, and we still see patients on high doses that interfere with thyroid labs.
Although biotin’s effects may merely cause confusion about puzzling thyroid lab results, some of the lab interferences could be very serious or even life threatening. An example of the latter was a a fatal missed case of myocardial infarction in a patient who had gone to the ED with chest pain but was discharged because troponin was (falsely) negative, as reported by an FDA communication from late 2017.
But regardless of such serious, life-threatening misdiagnoses like a missed MI, misdiagnosis of thyroid cases (eg, a patient with completely normal thyroid function misdiagnosed with Graves’ disease) can be problematic and even harmful. If such a patient is given anti-thyroid medication such as methimazole, unnecessarily, liver toxicity or neutropenia can result.
I am not sure if it is just me who struggles with biotin-induced lab interferences, but I suspect that this recently emerging biotin problem is quite prevalent in clinical practice but overlooked.
Please: Ask your patients about biotin!