BLOG: Medical alert jewelry proposed for biotin use
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Recently, my fellow and I saw a new patient who was referred for consultation about abnormal thyroid labs. I was a bit frustrated but also intrigued that this patient — aged at least 60 years and a retired administrator — had not heard about lab “glitches” associated with biotin use. She said one of her doctors recommended it for hair loss, and she has been taking it faithfully. Indeed, biotin is a great health product for hair, skin and-nails, as testified by all my patients who use it.
“Should I stop it?” she asked.
“No,” I said. “Just stop it for 1 week before any lab tests.”
She was told by her doctors that she had tested positive for Graves' disease; however, the doctors could not understand the total absence of hyperthyroid symptoms or goiter.
Known as vitamin B7, biotin intake can affect many lab tests, because the amount contained in these supplements is so much more than the daily allowance requirements. The daily requirements are 30 to 100 micrograms; supplements may contain 5,000 to 10,000 micrograms!
Thyroid labs for those who take biotin supplements can be falsely affected in a fashion that is consistent with Graves’ disease with hyperthyroidism, usually showing elevated thyroxine, triiodothyronine, thyroid stimulating immunoglobulin, and thyrotropin receptor antibody with low thyroid stimulating hormone.
After I answered her question stating that she would not need to stop biotin completely I added, “Except if God forbid you go to ER with chest pain!”
She wondered what I meant. I explained that many other lab results — not just thyroid labs — can be affected by biotin interference. Troponin, a commonly used diagnostic marker for heart attack, can appear to be falsely low due to biotin use. I explained to her that if she goes to the ER with chest pain and the doctors do not ask about biotin use, then a heart attack could be missed. That can lead to serious harm, including death, which has indeed happened. A case reported to the FDA in late 2017 with such a finding lead the FDA to issue the first warning about biotin lab interference.
My fellow, the patient and I thought about a medical alert bracelet or necklace stating, "I am taking biotin." We thought that this would be a great preventive measure, similar to type 1 diabetes, Addison’s disease, or other serious medical conditions that require attention during emergencies. Medical alert jewelry informs EMS personnel so they can use life-saving measures, such as sugar to treat coma due to hypoglycemia in type 1 diabetes, or cortisone in the case of adrenal crisis in Addison’s disease.
I call upon all clinicians to educate patients who use biotin to start wearing a biotin medical alert bracelet or necklace.