In the past few years, it has been widely shown that biotin supplements can and do interfere with some blood tests. These are tests which are based on "streptin-avidin".
The origin of this was that some people trialled extremely high doses of biotin in the hope it would help with multiple sclerosis. These are doses such as 300 to 500 milligrams - around a thousand times more than usual supplements. Possibly more than had ever previously been taken anywhere. And some of their blood tests returned unexpected results.
Test results could be higher or lower. And differences only occurred with some analytical processes - not all.
This ended up with several papers investigating the issues. And it was shown that biotin does affect some tests.
From the beginning, no-one involved has suggested that ordinary dietary levels of biotin, the amounts we typically get from food - something like 35 to 70 micrograms a day - have any effect on tests. Aside from anything else, they would have had to develop the tests using subjects not consuming that sort of biotin levels in their diets.
Similarly, supplements of low doses were not expected to be significant. For example, up to 100 micrograms a day.
This paper reports that the effects of up to 300 micrograms a day are unlikely to have any clinical relevance. And leaving off the supplement for two days should be sufficient.
The clinical significance of low dose biotin supplements (<300μg/day) in the treatment of patients with hypothyroidism: crucial or overestimated?
Nicholas Angelopoulos, Rodis D. Paparodis, Ioannis Androulakis, Panagiotis Anagnostis, Anastasios Boniakos, Leonidas Duntas, Spyridon N. Karras & Sarantis Livadas
Thyroid Research volume 16, Article number: 18 (2023)
Abstract
Background
In the last decade, the combination of the widespread use of streptavidin–biotin technology and biotin–containing supplements (BCS) in the daily clinical practice, have led to numerous reports of erroneous hormone immunoassay results. However, there are no studies assessing the clinical and biochemical significance of that phenomenon, when treating patients with hypothyroidism. Therefore, a prospective study was designed to investigate the potential alterations in the measurement of thyroid hormone concentrations and clinical consequences in patients with hypothyroidism using low-dose BCS containing less than 300 μg/day.
Methods
Fifty-seven patients on thyroxine supplementation, as a result of hypothyroidism and concurrent use of BCS at a dose <300μg/day for 10 to 60 days were prospectively evaluated. Namely, TSH and free T4 (FT4) concentration measurements were performed, during BC supplementation and 10 days post BCS discontinuation and compared to 31 age-matched patients with supplemented hypothyroidism and without BCS.
Results
A statistically significant increase in TSH and decline in FT4 concentrations was observed after BCS discontinuation. However, on clinical grounds, these modifications were minor and led to medication dose adjustment in only 2/57 patients (3.51%) in whom TSH was notably decreased after supplement discontinuation.
Conclusion
Our study suggests that changes in thyroid hormones profiling, due to supplements containing low dose biotin, are of minimal clinical relevance and in most cases don’t occult the need to adjust the thyroxine replacement dose in patients with hypothyroidism. Larger, well-designed trials are required to further evaluate this phenomenon.
https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/s13044-023-00162-8
This paper shows that high dose, 72 milligrams a day, does have an impact. The time between last dose and test to avoid any issues is not entirely clear but seven days is almost certainly long enough.
Endocr J. 2023 Jun 17.
doi: 10.1507/endocrj.EJ23-0062. Online ahead of print.
Elevated free thyroxine and free triiodothyronine probably caused by high-dose biotin intake in a patient with Graves' disease: a case report
Kento Shimmaru 1 2 , Mitsuhiro Inami 1 , Aya Hamaoka 1 , Noriko Fujiwara 1 , Tomoaki Morioka 2 , Masanori Emoto 2 , Nozomu Kamei 1
PMID: 37331797 DOI: 10.1507/endocrj.EJ23-0062
Abstract
Biotin is a water-soluble vitamin that acts as a cofactor for carboxylase, and is often used as a component in several immunoassays. We present a case of a 46-year-old male with Graves' disease (GD) who revealed elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels after high-dose biotin intake. Levels of these hormones had been within the reference range when he was on thiamazole 5 mg/day for 7 years; however, the levels increased from 1.04 to 2.20 ng/dL and from 3.05 to 9.84 pg/mL for FT4 and FT3, respectively, after he started taking biotin 72 mg/day. Despite these high levels, his symptoms and the other laboratory results, including the thyroid-stimulating hormone level, did not suggest GD relapse. His thyroid hormone data was decreased and returned within the reference range immediately after the laboratory assays for FT3 and FT4 had been coincidentally changed from those containing streptavidin-biotin complexes to biotin-free ones. Biotin interference, which is caused by high-dose biotin intake and immunoassays using some form of streptavidin-biotin complex, is sometimes clinically problematic, giving high or low results. To our knowledge, this is the first case report of a patient with GD on high-dose biotin receiving high thyroid hormone level results that were initially misunderstood as an aggravation of the disease; there are some reports of misdiagnosis of hyperthyroidism due to biotin administration. Unexpected fluctuations in thyroid function test results in patients with GD should be checked for biotin intake, immunoassays and the limiting concentration of biotin to avoid misdiagnosis of relapse.
Keywords: Biotin interference; Graves’ disease; Immunoassay; Streptavidin-biotin complex; Thyroid hormone.
https://www.jstage.jst.go.jp/article/endocrj/70/8/70_EJ23-0062/_article/-char/en
Summary
I've attempted to summarise the above into two simple statements which should ensure the worst mistakes are avoided.
If you are taking a low dose biotin supplement, anything measured in micrograms is probably low dose, leave at least two days before a blood draw. (Though their impact is likely to be small.)
If you are taking a higher dose biotin supplement, anything measured in milligrams is probably a high dose, leave at least seven days before a blood draw.
This Office of Dietary Supplements paper (from the USA) is worth reading:
Biotin
Fact Sheet for Health Professionals
https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/
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[i][b]helvella - Biotin supplementation and testing[/b]
A short article about how and why biotin can affect blood tests. Includes information about how to avoid any problems.[/i]
https://helvella.blogspot.com/p/helvella-biotin-supplementation-and.html
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