High-dose biotin therapy leading to false biochemical endocrine profiles: validation of a simple method to overcome biotin interference

2017 ◽  
Vol 55 (6) ◽  
pp. 817-825 ◽  
Author(s):  
Marie-Liesse Piketty ◽  
Dominique Prie ◽  
Frederic Sedel ◽  
Delphine Bernard ◽  
Claude Hercend ◽  
...  
Keyword(s):  
Simple Procedure ◽  
Thyroid Stimulating Hormone ◽  
Alternative Methods ◽  
High Dose ◽  
Endocrine Disorders ◽  
Free Triiodothyronine ◽  
Simple Method ◽  
Number Of Patients ◽  
Two Samples ◽  
Stimulating Hormone

Abstract Background: High-dose biotin therapy is beneficial in progressive multiple sclerosis (MS) and is expected to be adopted by a large number of patients. Biotin therapy leads to analytical interference in many immunoassays that utilize streptavidin-biotin capture techniques, yielding skewed results that can mimic various endocrine disorders. We aimed at exploring this interference, to be able to remove biotin and avoid misleading results. Methods: We measured free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), parathyroid homrone (PTH), 25-hydroxyvitamin D (25OHD), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, C-peptide, cortisol (Roche Diagnostics assays), biotin and its main metabolites (liquid chromatography tandem mass spectrometry) in 23 plasmas from MS patients and healthy volunteers receiving high-dose biotin, and in 39 biotin-unsupplemented patients, before and after a simple procedure (designated N5) designed to remove biotin by means of streptavidin-coated microparticles. We also assayed fT4, TSH and PTH in the 23 high-biotin plasmas using assays not employing streptavidin-biotin binding. Results: The biotin concentration ranged from 31.7 to 1160 µg/L in the 23 high-biotin plasmas samples. After the N5 protocol, the biotin concentration was below the detection limit in all but two samples (8.3 and 27.6 μg/L). Most hormones results were abnormal, but normalized after N5. All results with the alternative methods were normal except two slight PTH elevations. In the 39 biotin-unsupplemented patients, the N5 protocol did not affect the results for any of the hormones, apart from an 8.4% decrease in PTH. Conclusions: We confirm that most streptavidin-biotin hormone immunoassays are affected by high biotin concentrations, leading to a risk of misdiagnosis. Our simple neutralization method efficiently suppresses biotin interference.

Subclinical Hyperthyroidism: Diagnostic Criteria and Principles of Treatment

2016 ◽  
pp. 75-79
Author(s):  
Vita Galitskaya
Keyword(s):  
Hormone Receptors ◽  
Color Doppler ◽  
Specific Treatment ◽  
Nodular Goiter ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Subclinical Hyperthyroidism ◽  
Mineral Density ◽  
Free Triiodothyronine ◽  
Stimulating Hormone

This article presents the European Thyroid Association guidelines for diagnosis and treatment of subclinical hyperthyroidism, 2015. Determination of thyroid1stimulating hormone levels can help to diagnose a variety of pathological conditions: hypertension, cardiac fibrillation, atrial fibrillation, mineral density reduction in bones, menstrual irregularities, infertility, which require specific treatment after detection of hormonal status disorders (subclinical, overt), taking into account the patient’s age. Diagnosis of endogenous subclinical hyperthyroidism is based solely on the results of laboratory tests, not clinical criteria. Endogenous subclinical hyperthyroidism is defined by the presence of sub-normal levels of thyroid-stimulating hormone with normal levels of free thyroxine, total triiodothyronine, and/or free triiodothyronine. There are two categories of endogenous subclinical hyperthyroidism: stage 1 – the level of thyroid-stimulating hormone is 0,1–0,39 mIU/l; stage 2 – the level of thyroid-stimulating hormone is <0.1 mIU/l. The levels of free thyroxine and free triiodothyronine, as a rule, are medium-high value at a subclinical level of thyroid hormone and can help differentiate between endogenous subclinical hyperthyroidism from overt hyperthyroidism. It is recommended to study the thyroid-stimulating hormone level as the first test for the diagnosis of subclinical hyperthyroidism. In identifying low levels of thyroid-stimulating hormone it is necessary to investigate the level of free thyroxine, free or bound triiodothyronine. Patients with primary sub-normal levels of thyroid-stimulating hormone with concentration of thyroid hormones in the upper limit or in normal range should be evaluated within 2-3 months. It is recommended to perform scintigraphy and possible 24-hour test the absorption of radioactive iodine if in patient with 2nd degree endogenous subclinical hyperthyroidism there is nodular goiter to determine treatment strategy. Ultrasonography with color Doppler can be informative for patients with endogenous subclinical hyperthyroidism and nodular goiter. Determining the level of antibodies to thyroid-stimulating hormone receptors can confirm the etiology of autoimmune-induced hyperthyroidism.

Analytic Bias of Thyroid Function Tests: Analysis of a College of American Pathologists Fresh Frozen Serum Pool by 3900 Clinical Laboratories

2005 ◽  
Vol 129 (3) ◽  
pp. 310-317 ◽  
Author(s):  
Bernard W. Steele ◽  
Edward Wang ◽  
George G. Klee ◽  
Linda M. Thienpont ◽  
Steven J. Soldin ◽  
...  
Keyword(s):  
Proficiency Testing ◽  
Matrix Effects ◽  
Thyroid Stimulating Hormone ◽  
Analytic Method ◽  
Free Triiodothyronine ◽  
Analytic Methods ◽  
Clinical Laboratories ◽  
Target Values ◽  
Fresh Frozen ◽  
Stimulating Hormone

Abstract Context.—In proficiency testing surveys, there are differences in the values reported by users of various analytic methods. Two contributors to this variation are calibrator bias and matrix effects of proficiency testing materials. Objectives.—(1) To quantify the biases of the analytic methods used to measure thyroid-stimulating hormone, thyroxine, triiodothyronine, free thyroxine, and free triiodothyronine levels; (2) to determine if these biases are within allowable limits; and (3) to ascertain if proficiency testing materials correctly identify these biases. Design.—A fresh frozen serum specimen was mailed as part of the 2003 College of American Pathologists Ligand and Chemistry surveys. The means and SDs for each analytic method were determined for this sample as well as for a proficiency testing sample from both surveys. In the fresh frozen serum sample, target values for thyroxine and triiodothyronine were determined by isotope dilution/liquid chromatography/tandem mass spectrometry. All other target values in the study were the median of the means obtained for the various analytic methods. Main Outcome Measures.—Calibration biases were calculated by comparing the mean of each analytic method with the appropriate target values. These biases were evaluated against limits based on intra- and interindividual biological variation. Matrix effects of proficiency testing materials were assessed by comparing the rank of highest to lowest analytic method means (Spearman rank test) for each analyte. Participants.—Approximately 3900 clinical laboratories were enrolled in the College of American Pathologists Chemistry and Ligand surveys. Results.—The number of methods in the Ligand Survey that failed to meet the goals for bias was 7 of 17 for thyroid-stimulating hormone and 11 of 13 for free thyroxine. The failure rates were 12 of 16 methods for thyroxine, 8 of 11 for triiodothyronine, and 9 of 11 for free triiodothyronine. The means of the analytic method for the proficiency testing material correlated significantly (P &lt; .05) only with the fresh frozen serum means for thyroxine and thyroid-stimulating hormone in the Chemistry Survey and free triiodothyronine in the Ligand Survey. Conclusions.—A majority of the methods used in thyroid function testing have biases that limit their clinical utility. Traditional proficiency testing materials do not adequately reflect these biases.

Effect of Recombinant Human Erythropoietin (R-Huepo) Therapy on Plasma Ft3, FT4, TSH, FSH, LH, free Testosterone and Prolactin Levels in Hemodialysis Patients

1992 ◽  
Vol 15 (10) ◽  
pp. 585-589 ◽  
Author(s):  
M. Yeksan ◽  
N. Tamer ◽  
M. Cirit ◽  
S. Türk ◽  
G. Akhan ◽  
...  
Keyword(s):  
Free Testosterone ◽  
Hemodialysis Patients ◽  
Thyroid Stimulating Hormone ◽  
Sexual Disorders ◽  
Serum Prolactin ◽  
Control Group ◽  
Dialysis Session ◽  
Free Triiodothyronine ◽  
Human Erythropoietin ◽  
Stimulating Hormone

The aim of this study was to evaluate the effect of r-HuEPO treatment on free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and prolactin levels in uremic hemodialysis patients. Twenty-four uremic hemodialysis patients were given r-HuEPO with a dose 60 U/kg as intravenous bolus injection at the end of each dialysis session. Once the hematocrit value of the patient had reached a range of 30-35%, the dose was adjusted so as to keep the hematocrit levels constant. Twenty uremic dialysis patients were taken as control group. The above-mentioned hormone levels of patients and control group were determined before and 4 months after r-HuEPO treatment. After the treatment, serum prolactin levels significantly decreased in both sexes (36.8 ± 7.8 vs 22.9 ± 6.3 ng/ml and 78.3 ±13.3 vs 37.4 ± 10.4 ng/ml male and female, respectively). FT3 and FT4 significantly increased (1.17 vs 1.67 pg/ml, p<0.05, and 0.64 vs 0.084 ng/dl, p<0.05, respectively). TSH levels increased but those changes were not significant. There was no change in the level of any hormone in the control group. Also, the sexual functions of eight male patients treated with r-HuEPO improved and menstruation started again in four female patients. We concluded that r-HuEPO treatment especially decreases prolactin level in uremic hemodialysis patients. It is conceivable that correction of elevated prolactin levels could improve sexual disorders in these patients.

scholarly journals Misleading results from immunoassays of serum free thyroxine in the presence of rheumatoid factor

1997 ◽  
Vol 43 (6) ◽  
pp. 957-962 ◽  
Author(s):  
Anthony G W Norden ◽  
Rodwin A Jackson ◽  
Lorraine E Norden ◽  
A Jane Griffin ◽  
Margaret A Barnes ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Rheumatoid Factor ◽  
Equilibrium Dialysis ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Free Thyroxine ◽  
Free Triiodothyronine ◽  
Serum Free ◽  
Serum Free Thyroxine ◽  
Stimulating Hormone

Abstract A novel interference with measurements of serum free thyroxine (FT4) caused by rheumatoid factor (RhF) is described. We found misleading, sometimes gross, increases of FT4 results in 5 clinically euthyroid elderly female patients with high RhF concentrations. All 5 patients had high FT4 on Abbott AxSYM® or IMx® analyzers. “NETRIA” immunoassays gave misleading results in 4 of the 5 patients; Amerlex-MAB® in 2 of 4 patients; AutoDELFIA®in 2 of the 5; and Corning ACS-180® and Bayer Diagnostics Immuno 1® in 1 of the 5. BM-ES700® system results for FT4 in these women remained within the reference range. Results for serum T4, thyroid-stimulating hormone, free triiodothyronine, thyroid-hormone-binding globulin, and FT4 measured by equilibrium dialysis were normal in all 5 patients. Drugs, albumin-binding variants, and anti-thyroid-hormone antibodies were excluded as interferences. Addition to normal serum of the RhF isolated from each of the 5 patients increased the apparent FT4 (Abbott AxSYM). Screening of 83 unselected patients demonstrated a highly significant positive correlation between FT4 (Abbott AxSYM) and RhF concentrations. Discrepant, apparently increased FT4 with a normal result for thyroid-stimulating hormone should lead to measurement of the patient’s RhF concentration.

scholarly journals The ages and TSH values of patients being prescribed levothyroxine

2020 ◽  
Vol 11 ◽  
pp. 204201882093789
Author(s):  
Jacqueline Jonklaas ◽  
Sameer DeSale
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Specific Reference ◽  
Washington Dc ◽  
Reference Ranges ◽  
Time Period ◽  
Number Of Patients ◽  
Great Consideration ◽  
Slight Downward Trend ◽  
Ongoing Monitoring ◽  
Stimulating Hormone

Background: Levothyroxine is a commonly prescribed medication. Some data suggest that levothyroxine may be initiated for mild degrees of hypothyroidism and used without considering age-specific reference ranges or individual patient factors when prescribing. Methods: The electronic medical record of a health care system operating in the Washington, DC and Maryland area was interrogated to determine the number of patients who were being prescribed levothyroxine during the time period 2008–2016, the number of prescriptions supplied to these individuals, an associated diagnosis of hypothyroidism, and whether the prescriptions were new or existing prescriptions. Information was also extracted about the age of patients receiving prescriptions and the thyroid stimulating hormone level documented prior to levothyroxine initiation. Results: Although the number of levothyroxine prescriptions provided annually increased over this time period, when corrected for the number of patients in the database, the percentage of patients receiving levothyroxine prescriptions showed a slight downward trend. Levothyroxine was both most frequently prescribed and frequently initiated in those of ages 50–59 years and 60–69 years. The doses of levothyroxine most commonly prescribed were 50 µg and 100 µg and the pattern of levothyroxine doses being used was unaffected by whether a diagnosis of hypothyroidism was documented or not. Levothyroxine prescription initiation was associated with mean thyroid stimulating hormone values that were modestly elevated and in the range of 7.5–13.8 mIU/L. Conclusion: This analysis showed that although the percentage of patients being prescribed levothyroxine is stable or slightly declining, with most decrement in those without a diagnosis of hypothyroidism, there is nevertheless continued initiation of levothyroxine in those with mild degrees of thyroid stimulating hormone elevation, and in those of older age, raising concerns about both unnecessary treatment and iatrogenic thyrotoxicosis. Such data suggest the need for great consideration of both the degree of thyroid stimulating hormone elevation and the patient context when considering whether treatment of an elevated thyroid stimulating hormone value, versus ongoing monitoring, is indicated.

The study of effect of local therapy by essential oils applications on the dynamics of the immune and hormonal indicators and the optimization efficiency of rehabilitation treatment of patients with osteoarthritis

2015 ◽  
Vol 9 (1) ◽  
pp. 0-0
Author(s):  
Бобкова ◽  
A. Bobkova ◽  
Деревнина ◽  
N. Derevnina ◽  
Дашина ◽  
...  
Keyword(s):  
Essential Oils ◽  
Local Therapy ◽  
Thyroid Stimulating Hormone ◽  
Total Testosterone ◽  
Functional Index ◽  
Free Triiodothyronine ◽  
Cytotoxic Cells ◽  
Immunological Status ◽  
Optimization Efficiency ◽  
Stimulating Hormone

Purpose of this research is to study the effects of essential oils applications on the dynamics of the immune and hormonal indicators and clinical picture of osteoarthritis. Materials and methods. 30 women with osteoarthritis were treated by applications of mixture of essential oils: lavender, ginger, peppermint, rosemary, pine, clove, nutmeg, eucalyptus, thyme, anise. The dynamics of the immunological status: the total number of leucocytes; absolute and % of number of total lymphocytes, CD3,CD4+,CD8+, То cells, the indicators of immune-regulatory index CD4+/CD8+, absolute and % indicators CD19, IgG, IgA, IgM was studied. The dynamics of indicators of endocrine systems: somatotropic hormone, prolactin, cortisol, thyroid-stimulating hormone, free thyroxine, free triiodothyronine, paratiritis hormone, calci-tonin, osteocalcin, luteinizing hormone, follicle-stimulating hormone, estradiol and total testosterone, dehydroe-piandrosterone, aldosterone, progesterone, insulin , C-peptide, index HOMA-IR was examined. Results. Before treatment - immunodeficiency CD3, CD4, То cells, increasing CD8 cytotoxic cells, re-ducing the index CD4+ /CD8+ were revealed. After therapy – it was noted increasing CD4, То cells, reducing CD8, increasing the index CD4+ /CD8+. There were a statistically significant increase in testosterone (p&#60;0.05), reduced levels of insulin and glucose (p&#60;0.05), index, HOMA-IR (p&#60;0.05). Against the background of im-provement of immune and hormonal status, the decrease in pain and improvement of function of the joints, according to algo-functional index Lekena (p&#60;0.05), are marked.

scholarly journals Causal Association between Serum Thyroid-Stimulating Hormone and Obesity: A Bidirectional Mendelian Randomization Study

2021 ◽  
Author(s):  
Xichang Wang ◽  
Xiaotong Gao ◽  
Yutong Han ◽  
Fan Zhang ◽  
Zheyu Lin ◽  
...  
Keyword(s):  
Mendelian Randomization ◽  
Association Studies ◽  
Epidemiological Studies ◽  
Thyroid Stimulating Hormone ◽  
Genome Wide Association Studies ◽  
Causal Association ◽  
Free Triiodothyronine ◽  
The Impact ◽  
Serum Tsh ◽  
Stimulating Hormone

Abstract Context The association between serum thyroid-stimulating hormone (TSH) and obesity traits has been investigated previously in several epidemiological studies. However, the underlying causal association has not been established. Objective To determine and analyze the causal association between serum TSH level and obesity-related traits (BMI and obesity). Design, Setting, Participants The latest genome-wide association studies (GWASs) on TSH, BMI and obesity were searched to obtain full statistics. Bidirectional two-sample Mendelian randomization (MR) was performed to explore the causal relationship between serum TSH and BMI and obesity. The inverse variance-weighted (IVW) and MR-Egger methods were used to combine the estimation for each SNP. Based on the preliminary MR results, free thyroxine (fT4) and free triiodothyronine (fT3) levels were also set as outcomes to further analyze the impact of BMI on them. Main Outcome Measures BMI and obesity were treated as the outcomes to evaluate the effect of serum TSH on them, and TSH was set as the outcome to estimate the effect of BMI and obesity on it. Results Both IVW and MR-Egger results indicated that genetically driven serum TSH did not causally lead to changes in BMI or obesity. Moreover, the IVW method showed that the TSH level could be significantly elevated by genetically predicted high BMI (β=0.038, se=0.013, p=0.004). In further MR analysis, the IVW method indicated that BMI could causally increase the fT3 (β=10.123, se=2.523, p&lt;0.001) while not significantly affecting the fT4 level. Conclusion Together with fT3, TSH can be significantly elevated by an increase in genetically driven BMI.

Sign in / Sign up

Export Citation Format

Share Document