What Medications Can Affect The Thyroid Panel Tests
Many multivitamins, supplements , and over-the-counter and prescription medications may affect thyroid test results and their use should be discussed with your healthcare practitioner prior to testing. For example, biotin can interfere with some lab tests, so your healthcare practitioner may advise you to refrain from taking biotin or supplements that contain biotin for a few days before having blood drawn for a thyroid panel.
Reviewbest Practices In Mitigating The Risk Of Biotin Interference With Laboratory Testing
Increased use of high-dose biotin raises concerns about immunoassay interference.
Patients and physicians may be unaware of the presence of biotin in supplements.
Biotin interference thresholds vary by assay and by manufacturer.
Education of patients, physicians, and laboratory staff will increase awareness.
Best practice guidance is needed to prevent, detect, and manage biotin interference.
Do Any Of These Apply To You
Do your most recent lab results indicate:
- Deficient ferritin despite supplementing with ferritin and/or iron, but your lab result for ferritin is low or low/normal AND youre taking a high-dose biotin supplement
- Elevated Vitamin B12 and/or folate AND youre taking high-dose biotin supplement
- Abnormal thyroid markers that may suggest youre leaning more toward hyperthyroidism or, autoimmune thyroid disease such as Graves disease, or Hashitoxicosis and your symptoms align with hypothyroidism AND youre taking a high-dose biotin supplement . In this case, I highly recommend you also keep a log of the following: basal body temperature, heart rate, blood pressure, and symptom journal to share with your prescriber.
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Fda Warns That Biotin May Affect Some Lab Test Results
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More and more people are taking biotin also known as vitamin B7 because they believe it will improve their hair, nails, and skin. The daily recommended intake for an adult is 30 micrograms , but many biotin supplements marketed for beauty reasons contain much higher doses, ranging from 5,000 µg to 10,000 µg. And some new studies even suggest that mega doses of biotin could be used to treat diseases, such as neurodegenerative disorders like multiple sclerosis.
But biotin may interfere with some laboratory testing, causing results of tests to be either falsely high or falsely low. These inaccurate test results can cause healthcare practitioners to misdiagnose and mistreat their patients.
Excess biotin in patients blood samples can interfere with types of tests called immunoassays because many use biotin as part of the testing methodology. For example, some immunoassays use biotin to bind chemicals and other substances in the blood to the test tube so they can be measured. Excess biotin in the blood from supplements can block that binding and the substance wont be measured accurately.
The FDA urges the general public to that know that biotin is found in many over-the-counter supplements in levels that may interfere with laboratory tests. Examples include:
Biotin: Friend And Foe
Biotin can interfere with some test results. What can you do?
- You can continue taking supplements that contain biotin. It is a nutrient your body needs.
- Tell your health care practitioner if you take biotin or supplements containing biotin.
- Be proactive: know exactly what is in your supplements by carefully reading all labels.
- Talk to your health care practitioner or pharmacist if you are not sure if something contains biotin.
- Follow instructions from your health care practitioner who may advise you to avoid taking biotin before a scheduled blood draw.
- Alert your health care practitioner if you forget and take biotin before a scheduled blood draw.
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What Does Biotin Do
In simple terms, this vitamin helps convert your food to energy by helping to break down carbohydrates, fats and protein. In fact, the same is true for most b-vitamins!
But its also known to help hair growth, which is a big reason many with non-autoimmune hypothyroid, or autoimmune Hashimotos patients, take it!Hair loss can be common for some with hypothyroidism, or the attack on the thyroid, or having inadequate levels of iron.
Biotin also helps strengthen weak nails. All these improvements may take a few months. But patients do report seeing improvements to hair and nailseven skinfrom biotin.
In those with diabetes, there is some research showing it can help with lowering blood glucose levels.
Biotin Lab Test Interference
It has been well documented that biotin supplementation can interfere with several laboratory tests, not just tests involving the thyroid. Most studies note that small doses of biotin aren’t likely to significantly affect lab values, but it is certainly a possibility with high doses .
There are several theories as to why biotin can affect lab tests :
- Biotin may block test assay signals, leading to falsely elevated test results.
- Biotin may compete with biotin-containing complexes the test utilizes, which can lead to falsely low results.
Exactly which lab tests are potentially affected by biotin, and by what extent, isn’t well known and evidence suggests that there may even be variability from test to test or with tests from different manufacturers.
In November 2017, the FDA released a safety communication warning about biotin supplementation and lab tests:
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You Switched Between Synthroid And Levothyroxine
Because there may be subtle differences in how your body absorbs and processes the different thyroid medications, it is preferable to stay with one formulation when possible. The American Academy of Clinical Endocrinologists and American Thyroid Association recommend that you stick to brand-name Synthroid if thats what your provider first prescribed to you. And if you started with generic levothyroxine, youll not only want to keep taking the generic, but the generic made by the same manufacturer your pharmacist can help you with that.
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You Eat A Lot Of Fiber
A high-fiber diet is a good thing! But if youve recently changed your diet and added more high-fiber foods, know that they can interfere with your bodys absorption of your thyroid medications. Talk to your provider about how to manage this. It could mean spacing out when you eat and when you take your medications. Examples of popular high-fiber foods include:
Macro Thyroid Stimulating Hormone
Macro-TSH is a large form of TSH that results from the formation of complexes with serum proteins, including immunoglobulin. This form of TSH is not considered biologically active. Macro-TSH is detected by all current immunoassays, but because it cannot be routinely distinguished from active TSH, it can lead to falsely elevated TSH test results. Macro-TSH elevation should be suspected in asymptomatic individuals with markedly elevated TSH concentrations in isolation. Communication with the testing laboratory may be useful to determine possible testing strategies for macro-TSH.
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Biotin And Immune System
Thyroid hormones have a strong connection with the immune system. De Vito et al. found that both hyperthyroidism and hypothyroidism are associated with increased expression of pro-inflammatory cytokines which affect the immune system of an individual. Additionally, thyroid hormones affect natural killer cell activity as well as cell-mediated immune responses. Although the relationship between T3, T4, and immunity is complex, it is evident these hormones modulate immune responses.
Since people with thyroid problems are prone to decreased immunity, biotin could be helpful for improvement of the immune system. Agrawal et al. revealed that biotin deficiency intensifies pro-inflammatory cytokine responses of human dendritic cells. Our body needs biotin for the development of white blood cells that are vital for the immune system, and deficiency in this vitamin is associated with the impaired immune function. If you pair biotin deficiency and thyroid problems, then your immune system could be impaired significantly.
Wiedmann et al. found that biotin increases the production of Th1 cytokines such as IL-1 which is crucial for kick-starting an immune response to fight viral infections and bacteria. Bearing in mind that thyroid problems are linked to weakened immune response, biotin proves to be effective in improving your immunity.
Supplements For General Thyroid Health
If you walk down the supplement aisle of your favorite health food store, youll likely see a section dedicated to thyroid health.
Due to the prevalence of thyroid conditions, many supplement companies have started making supplements that are designed to support thyroid health.
Although some of these products are harmless, certain thyroid supplements may lead to negative side effects and can even harm your thyroid.
Before addressing why thyroid-specific supplements may not be the best choice for everyone, its important to explain what nutrients the thyroid needs for optimal functioning. Here are some of the most important nutrients for thyroid health:
- Selenium. Selenium, a mineral needed for thyroid hormone production, helps protect the thyroid from damage caused by oxidative stress. The thyroid contains high amounts of selenium, and a deficiency can lead to thyroid dysfunction .
- Iodine. Iodine is critical for thyroid function. In fact, currently, the only known role of iodine is to support thyroid hormone production. Triiodothyronine and thyroxine are thyroid hormones that contain iodine. Iodine deficiency causes thyroid disease .
- Zinc. The mineral zinc is required for thyroid hormone production. An optimal concentration of zinc is needed for healthy levels of T3, T4, and thyroid-stimulating hormone .
- Iron. The thyroid needs iron to convert T4 into T3, the active form of thyroid hormone. Iron deficiency is associated with thyroid dysfunction .
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Seleniums Impact On The Thyroid
In adults, the thyroid is the organ that has the highest concentration of selenium in the body, and this mineral plays a key role in your thyroid glands ability to produce thyroid hormone. Having an optimal amount of selenium in your diet is vital not just for preventing thyroid disease, but for your overall health.
A selenium deficiency is associated with a variety of thyroid issues, including:
- Thyroid cancer
- Graves disease
Iodinethe building block and key ingredient of thyroid hormoneactually requires selenium in order to be synthesized properly into thyroid hormone.
How Is The Test Used
A thyroid panel may be used to evaluate thyroid function and/or help diagnose thyroid disorders.
Typically, the preferred initial test for thyroid disorders is a TSH test. If the TSH level is abnormal, it will usually be followed up with a test for free T4. Sometimes a total T3 or free T3 will also be performed. Often, the laboratory will do this follow-up testing automatically. This is known as reflex testing and it saves the healthcare practitioner time from having to wait for the results of the initial test and then requesting additional testing to confirm or clarify a diagnosis. Reflex tests are typically performed on the original sample that was submitted when the initial test was requested.
As an alternative, a thyroid panel may be requested by your healthcare practitioner. This means that all three tests will be performed at the same time to get a more complete initial picture of thyroid function.
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What Foods Also Have Biotin/b7
Besides supplementation, you can find it in red meat, organ meat like liver, eggs, salmon, spinach, sweet potatoes, broccoli, mushrooms, seeds, and nuts. If you are hypothyroid, you may not be getting enough from foods due to the way hypothyroidism causes absorption problems in the stomach.
But as far as eggs, consuming raw egg whites can lower our biotin levels. So its far better to consume cooked eggs.
What Are The Symptoms Of Biotin Deficiency
Biotin deficiency Deficiency “a lack of, or shortage of something” is very rare. It can cause thinning hair and loss of body hair a rash around the eyes, nose, mouth, and anal area pinkeye high levels of acid in the blood and urine seizures skin infection brittle nails depression lethargy and pins and needles in the extremities.1
Symptoms of biotin deficiency in infants include weak muscle tone, sluggishness, and delayed development.4
Long term anti-seizure medication may cause a biotin deficiency as can eating egg whites over a long term.1
Biotin is promoted to be good for hair, skin and nail health. Some studies have shown that taking it improved brittle nails. However, although it is known that biotin deficiency causes hair loss, there are no studies showing that taking supplements improves hair loss.1
There are a few studies now that show that biotin is helpful for patients with MS.1
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Is There Anything Else I Should Know
In the past, panels of tests were more common. More recently, however, the practice has been to order, where possible, one initial or screening test and then follow up with additional testing, if needed, to reduce the number of unnecessary tests. With thyroid testing, one strategy is to screen with a TSH test and then order additional tests if the results are abnormal or if clinical suspicions warrant.
Your thyroid hormone test results can be affected by:
- Increases, decreases, and changes in the proteins that bind T4 and T3
Blog: Are You Taking Biotin
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Are you taking biotin?
It seems that, lately, I have been asking this question repeatedly to my clinic patients sometimes daily.
Last week, I saw a patient who follows with our endocrine clinic for a thyroid problem. For over 2 years, I have struggled with the interpretation of her thyroid function tests. I could not add up the lab results with her clinical status. She was asymptomatic, but her thyroid function tests have been abnormal.
Yes, I am, she answered.
When I asked her if she was taking biotin, she was kind of surprised, and I guess she had never been asked this question prior. At the same time, she acted as if she thought I was some kind of a genius to ask the question. I guess she may have thought to herself, wondering, How did the doctor know that I was taking biotin?
The rest of the dialogue went like something like this:
How long have you been on biotin? I asked.
For about 4 years, she replied.
And what strength? I asked.
Five mg daily, she replied.
But biotin is not listed on your medications list in the EMR, I said.
Oh, I am sorry, I did not realize it was a medication, she explained.
The medications are usually reviewed by our medical assistants at the check-in, and then by clinicians during the office visit. Clearly, we have missed this important piece in the patients medication history.
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You Started Estrogen Hormone Replacement Therapy
A TSH blood test should be done 12 weeks after starting estrogen therapy to check your thyroid hormone levels. Estrogen, which is available as a pill, injection, or different skin preparations , can affect your thyroid medication. Women taking estrogen therapy may need more Synthroid or levothyroxine.
Collagen And Thyroid Relationship
Collagen is a type of protein family that has a number of important roles to play in structures of the body, including the skin, organs, and other tissues.
There are many different types of collagen that have been discovered. Collagen II marked significant importance for the medical science industry, discovered in 1969 by Miller and Matukas1. Since this time, at least 26 other types of collagen have also been identified, bring the total number of these collagen molecules to more than 28 different types.
Some collagen types are more common than others. Collagen II in particular primarily makes up cartilage in the body, while type I is found in organs, tendons, bone tissue, and the skin.
Collagen type III is known as a reticulate type of collagen, type IV forms the basal lamina, and type V plays an important role in placenta, hair, and the surface of cells.
Even though a crucial component of many structures within the human body, collagen can be unhealthy in some cases as well, especially when a buildup of collagen occurs in certain regions.
In this article, we are examining the relationship that exists between the Thyroid gland, the secretion of Thyroid hormones, disorders that affect this particular gland, and collagen throughout the body.
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Fda Warns Biotin Can Distort Lab Tests
Nov. 29, 2017 — The FDA is warning that high doses of vitamin B7, or biotin, in dietary supplements can interfere with hundreds of common lab tests — including some that emergency room doctors rely on to diagnose a heart attack. The problem has led to at least one death.
Biotin is in many multivitamins. Itâs also sold in formulas that are marketed to improve hair and nail growth. A 5- to 10-milligram dose — an amount thatâs commonly added to supplements — is 166 times to 333 times more than the 30 micrograms most people need in their diets every day.
In some cases, extra biotin causes falsely high results on tests. In others, it causes the results to read as falsely low.
Thatâs true with some ways to detect a protein called troponin, which rises after heart muscle has been damaged. Doctors use the troponin test in the emergency room to find out whether a patientâs chest pain is from heartburn or a heart attack.
The FDA says a patient who was taking high levels of biotin died when a troponin test failed to show he was having a heart attack.
Experts say the problem is not new.
âIn the lab community, people have known about this for a long time,â said Danni Li, PhD, director of clinical chemistry at the University of Minnesota Medical Center.