Biotin Supplementation Research Articles

8581 Unusual Case of Multifactorial Hyperthyroidism

Abstract Disclosure: D.D. Bagar: None. E. Meyers: None. M. Correia: None. Background: Nivolumab is an immune checkpoint inhibitor that is used to treat specific types of cancer, including melanoma, by increasing the ability of the immune system to detect cancer through activating cytotoxic T-cells. The side effects of immune checkpoint inhibitors are mainly through the overactivation of the immune system that can affect many organs with autoimmune diseases, including endocrine glands, which could be severe and irreversible, like hypothyroidism or immune thyroiditis. The uniqueness of this case is the presence of multifactorial causes of hyperthyroidism; in addition, it is one of the few cases of immune checkpoint inhibitor induced positive TSI thyroiditis.Clinical Case: An 82-year-old male with a known history of atrial fibrillation on amiodarone presented to his dermatologist with a left forearm lesion. A shave biopsy showed melanoma, and he underwent wide local excision with negative sentinel lymph node biopsy. However, he had significant melanoma in situ present within 5 mm of the margin and was deemed not a candidate for further excision. Tumor board recommended close surveillance. He then received two cycles of pembrolizumab for one year, followed by nivolumab. During his treatment course, he had CT scans with iodinated contrast every 8-12 weeks for the clinical trial. At his clinic visit, routine thyroid function tests were significant for hyperthyroidism with a TSH <0.01 and free T4 of 6.07 (0.8-1.8). He was asymptomatic except for unintentional weight loss. He denied using any biotin supplements. His labs also showed positive thyroid stimulating immunoglobulin (TSI) of 1.10 (<=0.54 IU/L). A thyroid US with doppler showed two nodules less than 1.1 cm and no increased vascularity. Amiodarone was discontinued, and prednisone and methimazole were started. His free T4 has since normalized and both prednisone and methimazole are being tapered down. Conclusion: This case is a multifactorial cause of hyperthyroidism. He had been using amiodarone for atrial fibrillation, had multiple imaging studies with iodinated contrast, and was on immune checkpoint inhibitor therapy with a positive TSI. The uniqueness of this case is not only that combined factors can affect thyroid function but also that he developed a positive TSI, which indicates either Graves’ disease or immune-induced thyroiditis by nivolumab, which has been reported only in a few cases. Presentation: 6/3/2024

8208 Unexpected And Significant Rise In TSH In The Setting Of Relugolix Use

Abstract Disclosure: A.Y. Groysman: None. A. Poloju: None. P. Majety: None. T. Abraham: None. Background: Relugolix is a gonadotropin-releasing hormone antagonist used as androgen deprivation therapy for metastatic and nonmetastatic castration-resistant prostate cancer that was FDA-approved in December 2020. Common side effects include hot flashes, increased glucose and triglycerides, and decreased hemoglobin. We report a case of Relugolix interference with the absorption of levothyroxine, which has not been reported in the literature. Case: A 79-year-old white man with high-risk, Gleason 9 prostate cancer and Hashimoto’s hypothyroidism presented for evaluation of elevated thyroid stimulating hormone (TSH) level- 52.87 mIU/L (0.28-4.10 mIU/L). He did not have cold intolerance, constipation, fatigue, or weight gain. He was diagnosed with hypothyroidism in 1998 and was on a stable dose of levothyroxine 88mcg daily from 2016 until the time of this presentation. He is adherent and reports following a routine of having breakfast with coffee soon after taking levothyroxine for many years. In June 2022, his TSH was 4.48 mIU/L. In July 2022, he started taking Relugolix along with levothyroxine. Following this, his TSH levels increased to 30.08 mIU/L (FT4: 0.67 ng/dL), 35.43 mIU/L (FT4: 0.57 ng/dL), 52.87 mIU/L (FT4: 0.48 ng/dL) on 2/24/23, 3/3/23, and 3/14/23, respectively. No new medications were reported. His other medications were atorvastatin, tamsulosin, and vitamin D, which he took at night. He did not take calcium or biotin supplements. He had gradual weight gain (8 lbs) over the last 9 months. Levothyroxine dose was increased from 88 to 125 mcg daily and he was instructed to separate Relugolix from levothyroxine so he started taking Relugolix at bedtime. Repeat TSH was low at 0.12 mIU/L. The levothyroxine dose was eventually titrated back to 88 mcg daily and TSH was 5.2 (appropriate for age). Conclusion: Several medications are known to interfere with the absorption of levothyroxine. Our case suggests that Relugolix may be one of them. The significant rise in TSH and levothyroxine requirements months after starting Relugolix and the ability to return to the previous dose of levothyroxine only by separating Relugolix from levothyroxine strongly suggests that there is an interference between these medications that has not been reported. Presentation: 6/2/2024

8581 Unusual Case Of Multifactorial Hyperthyroidism

Abstract Disclosure: D.D. Bagar: None. E. Meyers: None. M. Correia: None. Background: Nivolumab is an immune checkpoint inhibitor that is used to treat specific types of cancer, including melanoma, by increasing the ability of the immune system to detect cancer through activating cytotoxic T-cells. The side effects of immune checkpoint inhibitors are mainly through the overactivation of the immune system that can affect many organs with autoimmune diseases, including endocrine glands, which could be severe and irreversible, like hypothyroidism or immune thyroiditis. The uniqueness of this case is the presence of multifactorial causes of hyperthyroidism; in addition, it is one of the few cases of immune checkpoint inhibitor induced positive TSI thyroiditis.Clinical Case: An 82-year-old male with a known history of atrial fibrillation on amiodarone presented to his dermatologist with a left forearm lesion. A shave biopsy showed melanoma, and he underwent wide local excision with negative sentinel lymph node biopsy. However, he had significant melanoma in situ present within 5 mm of the margin and was deemed not a candidate for further excision. Tumor board recommended close surveillance. He then received two cycles of pembrolizumab for one year, followed by nivolumab. During his treatment course, he had CT scans with iodinated contrast every 8-12 weeks for the clinical trial. At his clinic visit, routine thyroid function tests were significant for hyperthyroidism with a TSH <0.01 and free T4 of 6.07 (0.8-1.8). He was asymptomatic except for unintentional weight loss. He denied using any biotin supplements. His labs also showed positive thyroid stimulating immunoglobulin (TSI) of 1.10 (<=0.54 IU/L). A thyroid US with doppler showed two nodules less than 1.1 cm and no increased vascularity. Amiodarone was discontinued, and prednisone and methimazole were started. His free T4 has since normalized and both prednisone and methimazole are being tapered down. Conclusion: This case is a multifactorial cause of hyperthyroidism. He had been using amiodarone for atrial fibrillation, had multiple imaging studies with iodinated contrast, and was on immune checkpoint inhibitor therapy with a positive TSI. The uniqueness of this case is not only that combined factors can affect thyroid function but also that he developed a positive TSI, which indicates either Graves’ disease or immune-induced thyroiditis by nivolumab, which has been reported only in a few cases. Presentation: 6/3/2024

Biotin Supplementation Improved Reproductive Parameters Following Lead Induced Testicular Toxicity in Male Wistar Rats

Lead acetate, a prominent heavy metal, is released into the environment by various industries like paint, ceramics, lead-containing pipes, and plastics. Exposure to lead acetate has adverse effects on numerous organs in the body, with a particular impact on the testes due to its distinctive vascular system. The present study investigated the potential protective effects of biotin on lead acetate-induced testicular damage in Wistar rats. Twenty (20) male Wistar rats were divided into 4 groups: control (animal feed daily with water); negative control (lead acetate 60 mg/kg); Positive control group( high-dose Biotin (80mg/kg) and the treatment group Lead acetate (60mg/kg)/high-dose Biotin (80mg/kg). After 28 days of administration, blood samples were collected for hormonal assay, and semen from the epididymis for semen profile. Testicular samples were also collected for histopathological studies. Results showed that lead acetate administration significantly decreased the sperm count, motility, viability, and altered histology of the testis (testicular damage, necrosis of seminiferous tubules, and loss of spermatid) compared to the negative control. However, the treatment group showed significantly improved histology of the testis, and increased sperm count, motility, and viability. From the results of this study, it could be concluded that biotin supplementation could provide a promising ameliorative effect against lead acetate-induced testicular toxicity.

Hair loss due to pollution, micro metabolic dysfunction, epigenetics and role of nutrients

Introduction: Hair is unknowingly and unwillingly exposed to pollution through air, water, food, temperature, humidity, UV rays, circadian rhythm, electromagnetic radiation and noise, which alter cellular functions and genetic expression through the generation of reactive oxygen species (ROS). The ROS causes subclinical micro metabolic dysfunction, resulting in anagen arrest or telogen extension leading to hair loss that mimics AGA. Nutrients can repair cell damage, neutralize the ROS, restore cellular function, counter inflammation, build immunity and correct epigenetic changes, to achieve hair growth. Objective: To understand metabolic damage inflicted by pollutants through ROS, epigenetic effects and the role of nutrients. Material and methods: Study includes 63 patients, 37 male and 26 female between 18 to 38 years of age, who matched the criteria for hair loss due to pollution. Every patient received oral supplements of curcumin, quercetin, N-acetyl cysteine, vitamin A, C, D, E, B-complex, biotin, iron, folic acid, epigallocatechin gallate, amino acids and omega 3 for 4 months. Nutrients were administered in synergistic combinations on different days of the week. Observation and results: Diffuse hair loss, itching, irritation, redness, sebum, dandruff, grime, burning, trichodynia, dry frizzy, brittle hair were common. Marginally raised heart rate, blood pressure, low hemoglobin, low as well as high serum ferritin, low vitamin D, raised TSH and low T3, T4 were detected. Men and women had an average improvement of 16-21% in density with 18-22% improvement in caliber. Conclusion: Nutrients can counter the mechanisms of pollution and achieve hair growth without finasteride, antiandrogens or minoxidil.

Rad6 Regulates Conidiation by Affecting the Biotin Metabolism in Beauveria bassiana.

Rad6 is a canonical ubiquitin-conjugating enzyme known for its role in regulating chromosome-related cellular processes in yeast and has been proven to have multiple functions in Beauveria bassiana, including insect-pathogenic lifestyle, UV damage repair, and conidiation. However, previous studies have only reported the key role of Rad6 in regulating conidial production in a nutrient-rich medium, without any deep mechanism analyses. In this study, we found that the disruption of Rad6 leads to a profound reduction in conidial production, irrespective of whether the fungus is cultivated in nutrient-rich or nutrient-poor environments. The absence of rad6 exerts a suppressive effect on the transcription of essential genes in the central developmental pathway, namely, brlA, abaA, and wetA, resulting in a direct downregulation of conidiation capacity. Additionally, mutant strains exhibited a more pronounced decline in both conidial generation and hyphal development when cultured in nutrient-rich conditions. This observation correlates with the downregulation of the central developmental pathway (CDP) downstream gene vosA and the upregulation of flaA in nutrient-rich cultures. Moreover, single-transcriptomics analyses indicated that irregularities in biotin metabolism, DNA repair, and tryptophan metabolism are the underlying factors contributing to the reduced conidial production. Comprehensive dual transcriptomics analyses pinpointed abnormal biotin metabolism as the primary cause of conidial production decline. Subsequently, we successfully restored conidial production in the Rad6 mutant strain through the supplementation of biotin, further confirming the transcriptomic evidence. Altogether, our findings underscore the pivotal role of Rad6 in influencing biotin metabolism, subsequently impacting the expression of CDP genes and ultimately shaping the asexual life cycle of B. bassiana.

The Beneficial Effects of Prenatal Biotin Supplementation in a Rat Model of Intrauterine Caloric Restriction to Prevent Cardiometabolic Risk in Adult Female Offspring.

Numerous studies indicate that intrauterine growth restriction (IUGR) can predispose individuals to metabolic syndrome (MetS) in adulthood. Several reports have demonstrated that pharmacological concentrations of biotin have therapeutic effects on MetS. The present study investigated the beneficial effects of prenatal biotin supplementation in a rat model of intrauterine caloric restriction to prevent cardiometabolic risk in adult female offspring fed fructose after weaning. Female rats were exposed to a control (C) diet or global caloric restriction (20%) (GCR), with biotin (GCRB) supplementation (2 mg/kg) during pregnancy. Female offspring were exposed to 20% fructose (F) in drinking water for 16 weeks after weaning (C, C/F, GCR/F, and GCRB/F). The study assessed various metabolic parameters including Lee's index, body weight, feed conversion ratio, caloric intake, glucose tolerance, insulin resistance, lipid profile, hepatic triglycerides, blood pressure, and arterial vasoconstriction. Results showed that GCR and GCRB dams had reduced weights compared to C dams. Offspring of GCRB/F and GCR/F dams had lower body weight and Lee's index than C/F offspring. Maternal biotin supplementation in the GCRB/F group significantly mitigated the adverse effects of fructose intake, including hypertriglyceridemia, hypercholesterolemia, hepatic steatosis, glucose and insulin resistance, hypertension, and arterial hyperresponsiveness. This study concludes that prenatal biotin supplementation can protect against cardiometabolic risk in adult female offspring exposed to postnatal fructose, highlighting its potential therapeutic benefits.

Oxford nanopore sequencing-based assay for BTD gene screening: Design, clinical validation, and variant frequency assessment in the Turkish population

Biotinidase deficiency (BTD) is an autosomal recessive disorder characterized by impaired recycling of the water-soluble vitamin biotin which leads to a spectrum of clinical manifestations ranging from mild to severe, including mainly neurological and cutaneous symptoms. Biotin supplementation is a cornerstone of treatment, but diagnosis often relies on measuring serum enzyme activity, which needs to be confirmed by genetic analysis. Thus, molecular methods become necessary in the differential diagnosis of BTD. Accordingly, countries with a high-incidence have implemented next-generation sequencing (NGS) techniques to newborn screening programs for BT. Nevertheless, NGS platforms, while well-established, present challenges in cost, labor, accessibility, and duration for newborn screening programs targeting BTD, therefore these limitations necessitate the exploration of alternative systems to ensure efficient and widespread screening. Here, third-generation sequencing platforms, notably Oxford Nanopore Technology (ONT), present promising solutions to the associated challenges. Hence, in the present study, we aimed to develop an ONT-based assay for the screening of BTD gene. After designing and optimizing primers for long-PCR using reference DNA, we assessed the performance of the ONT assay in BTD patients previously diagnosed by enzyme assay and confirmed using Illumina-based sequencing. The results demonstrate a strong correlation between the two methods, indicating the reliability of the ONT-based assay. Moreover, this first in-house single gene testing specifically tailored for BTD successfully detected previously known genetic variants with high sequencing depths, affirming the effectiveness of ONT-based sequencing in human genetics.

Derivation of two iPSC lines (KAIMRCi004-A, KAIMRCi004-B) from a Saudi patient with Biotin-Thiamine-responsive Basal Ganglia Disease (BTBGD) carrying homozygous pathogenic missense variant in the SCL19A3 gene

The neurometabolic disorder known as biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare autosomal recessive condition linked to bi-allelic pathogenic mutations in the SLC19A3 gene. BTBGD is characterized by progressive encephalopathy, confusion, seizures, dysarthria, dystonia, and severe disabilities. Diagnosis is difficult due to the disease’s rare nature and diverse clinical characteristics. The primary treatment for BTBGD at this time is thiamine and biotin supplementation, while its long-term effectiveness is still being investigated. In this study, we have generated two clones of induced pluripotent stem cells (iPSCs) from a 10-year-old female BTBGD patient carrying a homozygous mutation for the pathogenic variant in exon 5 of the SLC19A3 gene, c.1264A > G (p.Thr422Ala). We have confirmed the pluripotency of the generated iPS lines and successfully differentiated them to neural progenitors. Because our understanding of genotype–phenotype correlations in BTBGD is limited, the establishment of BTBGD-iPSC lines with a homozygous SLC19A3 mutation provides a valuable cellular model to explore the molecular mechanisms underlying SLC19A3-associated cellular dysfunction. This model holds potential for advancing the development of novel therapeutic strategies.

Case - Biotin supplements interfering with prostate-specific antigen assays: A cautionary tale.

Case - Biotin supplements interfering with prostate-specific antigen assays: A cautionary tale.

The protective effect of biotin supplementation and swimming training on cognitive impairment and mental symptoms in a rat model of Alzheimer's disease: A behavioral, biochemical, and histological study

Vitamin B (Vit B) plays a regulatory role in cognitive memory and learning. We examined the biochemical and behavioral effects of biotin supplementation (BS) and swimming training (ST) on Alzheimer's disease (AD), the most common type of dementia, in male rats. Sixty rats were randomly assigned to six groups: control, sham (receiving phosphate-buffered saline), AD (receiving a single injection of Aβ into the lateral ventricle), ST (for 28 days and before Aβ injection), and BS (receiving BS through oral gavage for 28 days before Aβ injection). The treatments were continued until the end of the behavioral tests. Learning and memory functions were investigated through the Morris water maze (MWM) and depression and anxiety-like behaviors were tested by elevated plus-maze (EPM) and forced swimming tests. In addition, oxidative stress biomarkers, such as total thiol groups (TTG) and malondialdehyde (MDA) in serum were assessed and histological studies were performed using brain tissues. In the AD group, Aβ increased the distance traveled and escape latency in the MWM, but co-administration of BS and ST attenuated the results of the MWM, EPM, and FST tests. Furthermore, BS decreased the litigious biochemical effects of Aβ by enhancing the levels of TTG, in addition to reducing serum MDA levels. The use of BS as a potent antioxidant improved Aβ-induced memory impairment. It attenuated oxidative stress biomarkers in the brain (number of Aβ plaques) and serum of AD rats. We provide evidence for the use of BS in neurodegenerative disorders, such as AD, to elucidate the possible mechanisms.

Effect of Formic Acid and Biotin Supplementation on Growth Performance and Survival of the Carp Fish Challenged with Vibrio parahaemolyticus Infection

Effect of Formic Acid and Biotin Supplementation on Growth Performance and Survival of the Carp Fish Challenged with Vibrio parahaemolyticus Infection

Productive Performance and Serum Biochemical Parameters of Nile Tilapia Fingerlings Fed on Different Dietary Carbohydrate: Protein Ratios with Biotin Supplementation

The current experiment evaluated the effects of different dietary carbohydrate: protein ratios (CHO: CP ratio) without or with biotin supplementation on the growth performance, body composition, serum biochemical parameters and intestinal morphology in Nile tilapia. Fingerlings were assigned to 6 treatments arranged as following; Group 1 (G1) fed the basal diet (BD) with a medium CHO: CP ratio (47:32); G2 with high CHO: CP ratio (57:21); G3 with low CHO: CP ratio (36:42); while G4, G5 and G6 had the same previous experimental design of the first 3 groups but with biotin supplementation (0.06 mg/kg diet). The growth performance was only assessed for the first 6 weeks, then the experiment continued to 4 months and ended by sampling for other parameters determined. Fish feeding on high CHO: CP ratio (57:21) significantly reduced the fish body weight, gain and feed intake (FI) (P ≤ 0.05), while improved the feed efficiency compared to the medium and low ratios. Biotin addition to the high or the medium ratios containing diets resulted in lower growth, increased FI and deteriorated the feed efficiency when compared to their control groups without biotin addition (P≤ 0.05). Different dietary CHO: CP ratios significantly altered tilapia body composition of nutrients (moisture, EE, and ash), serum parameters (glucose, triglyceride, LDL and VLDL) and the liver function enzymes (GPT and GOT) (P≤ 0.05). The relative mRNA expression of GHR and IGF was significantly upregulated in fish fed on the low and the high ratios containing diets respectively. In conclusion, feeding of the early fingerling of tilapia on the high CHO: CP ratio during the first 6 weeks of life resulted in lower growth, however, it showed a protein sparing effect. Supplementation of biotin (extra over the diet) was not recommended as it showed adverse effects on tilapia growth especially during the first periods of life, however it showed some beneficial effects on alleviating the high-dietary carbohydrate-induced effects. Feeding on medium CHO: CP ratio (47:32) or low ratio (36:42) would be recommended during the fry and early fingerling stage of tilapia while the high ratio (57:21) would be beneficial in the diet of late fingerlings or adult tilapia.

Biotinidase biochemical and molecular analyses: Experience at a large reference laboratory.

Biotinidase deficiency is caused by absent activity of the biotinidase, encoded by the biotinidase gene (BTD). Affected individuals cannot recycle the biotin, leading to heterogeneous symptoms that are primarily neurological and cutaneous. Early treatment with biotin supplementation can prevent irreversible neurological damage and is recommended for patients with profound deficiency, defined as enzyme activity <10% mean normal (MN). Molecular testing has been utilized along with biochemical analysis for diagnosis and management. In this study, our objective was to correlate biochemical phenotype/enzyme activity to BTD genotype in patients for whom both enzyme and molecular testing were performed at our lab, and to review how the correlations inform on variant severity. We analyzed results of biotinidase enzyme analysis and BTD gene sequencing in 407 patients where samples were submitted to our laboratory from 2008 to 2020. We identified 84 BTD variants; the most common was c.1330G>C, and 19/84 were novel BTD variants. A total of 36 patients had enzyme activity <10% of MN and the most common variant found in this group was c.528G>T. No variant was reported in one patient in the profound deficiency group. The most common variant found in patients with enzyme activity more than 10% MN was c.1330G>C. Although enzyme activity alone may be adequate for diagnosing profound biotinidase deficiency, molecular testing is necessary for accurate carrier screening and in cases where the enzyme activity falls in the range where partial deficiency and carrier status cannot be discriminated.

Alopecia, Dermatitis and Seizures since Infancy: A Case of Biotinidase Deficiency

Abstract Background: Biotinidase deficiency is a rare autosomal recessive metabolic disorder, having a wide spectrum of neurological, cutaneous, and immune-dysfunction-related clinical manifestations, which may be overlooked as common pediatric ailments. Clinical Description: A 2-year–7-month-old girl child, second born to third-degree consanguineous parents, presented with fast breathing and altered sensorium for a day, with a history of seizures and skin lesions since early infancy, developmental delay, and ataxia. Management and Outcome: Investigations revealed a normal septic screen, with metabolic acidosis which was unresponsive to therapy. After stabilizing the child with respiratory and vasopressor support, investigations for immunodeficiency were sent. Tandem mass spectrometry revealed increased C5OH levels, suggestive of holocarboxylase deficiency. Specific enzyme assay showed biotinidase activity deficiency. The child was initially empirically treated with metabolic cocktail comprising carnitine, biotin, thiamine, C0-enzyme Q10, and riboflavin, followed by specific therapy with biotin. The child showed dramatic clinical improvement and normalization of blood gas. Treatment has been advised lifelong with biotin supplementation. Conclusion: Careful observation by a pediatrician can identify the typical combination of clinical features in a child, suggestive of biotinidase deficiency. Evaluation and management of the condition are simple and rewarding.

An Analysis of the Biotin-(Strept)avidin System in Immunoassays: Interference and Mitigation Strategies.

An immunoassay is an analytical test method in which analyte quantitation is based on signal responses generated as a consequence of an antibody-antigen interaction. They are the method of choice for the measurement of a large panel of diagnostic markers. Not only are they fully automated, allowing for a short turnaround time and high throughput, but offer high sensitivity and specificity with low limits of detection for a wide range of analytes. Many immunoassay manufacturers exploit the extremely high affinity of biotin for streptavidin in their assay design architectures as a means to immobilize and detect analytes of interest. The biotin-(strept)avidin system is, however, vulnerable to interference with high levels of supplemental biotin that may cause elevated or suppressed test results. Since this system is heavily applied in clinical diagnostics, biotin interference has become a serious concern, prompting the FDA to issue a safety report alerting healthcare workers and the public about the potential harm of ingesting high levels of supplemental biotin contributing toward erroneous diagnostic test results. This review includes a general background and historical prospective of immunoassays with a focus on the biotin-streptavidin system, interferences within the system, and what mitigations are applied to minimize false diagnostic results.

FRI518 Good For Hair, Skin, And Nails But Bad For Thyroid Lab Tests

Abstract Disclosure: S. Khan: None. P. Kachhadia: None. S. Aldasouqi: None. A. Abu Limon: None. Introduction: Biotin also known as Vitamin B7 is very commonly used for hair, skin and nail growth. It can cause falsely high levels of free thyroxine (FT4), and free triiodothyronine (FT3) and falsely low thyroid stimulating hormone (TSH) levels. This can lead to a false diagnosis of hyperthyroidism. The ATA has recommended to stop taking biotin at least 2 days prior to lab testing to avoid spurious results. We present a case of a patient with hypothyroidism on a stable dose of levothyroxine who developed abnormal thyroid function tests (TFTs) due to biotin supplements. Case Presentation: A 57 years old female with long-standing hypothyroidism had been a on stable dose of Levothyroxine, 100 mcg daily. She was compliant with treatment. Her TFTs, done on periodic follow ups every 3-6 months were normal. Recently, on semi-annual lab work, thyroid function tests revealed elevated free T4 and T3, but normal TSH values. The patient was clinically euthyroid. Due to the unexpected thyroid function test result which did not portray clinical hyperthyroidism, repeat detailed history was taken which revealed that the patient was taking Biotin 1000 mg twice daily, as a hair-skin-nail beauty product. TFTs were repeated after she was instructed to stop Biotin for 3 days, which resulted in normal values. Patient was well-educated by our team to stop Biotin before labs, in the future. Once again, close to a year later, TFTs showed elevated FT4 and borderline low TSH. When contacted, she admitted forgetting to stop Biotin before labs. Labs off biotin once more showed normalization of FT4. Discussion: A variety of laboratory immunoassay blood tests utilize Biotin (Vitamin B7) in view of its high affinity to Streptavidin. At physiological concentrations, Biotin does not interfere with thyroid function tests. However, excessive Biotin use which is often taken as a beauty supplement is known to interfere with these tests. Typically, excessive Biotin intake will result in falsely elevated T4 and T3 and falsely low TSH. Furthermore, it will result in falsely elevated immunoglobulins that are markers for Graves’ disease. Our patient was taking a total of 2000mcg of biotin daily over the counter. This interference, which is not uncommon in clinical practice, has led to many misdiagnoses with potential for unnecessary workup, and sometimes initiation of inappropriate or potentially harmful treatment regimens. In this case report, though this patient’s thyroid function test results were suggestive of hyperthyroidism, biotin use is what caused in-vitro interference with the Biotin-Streptavidine Immunoassay. For this reason, clinicians should remain attentive to common biotin use in patients and advise them to hold biotin at least 2 days before labwork to avoid such outcomes. Furthermore, lab centers should also be informed of this interference and should avoid lab draw in those patients did that not hold biotin appropriately. Presentation: Friday, June 16, 2023

SAT495 Persistent Euthyroid State in a Patient with Biochemical and Imaging Evidence of Graves' Disease

Abstract Disclosure: M. Antony: None. S. Gundlapally: None. M. Joglekar: None. B. Fritz: None. S. Patel: None. V. Verma: None. R. Kant: None. INTRODUCTION: Elevated TSI antibody and/or diffuse uptake on radioactive Iodine-123 scan is diagnostic of Graves’ disease. Thyromegaly with increased blood flow on color doppler seen on thyroid USG can also aid in the diagnosis. Rare presence of positive TSI antibody without hyperthyroidism has been reported1. Rare co-existence of both Graves’ disease and Hashimoto’s thyroiditis in a patient causing a challenging clinical course has been reported2. Presence of a neutralizing or blocking antibody against the TSH receptor1 or a false positive TSI have been implicated in such rare cases. CLINICAL CASE: A 37-year-old Caucasian Female was seen at our endocrinology clinic for further evaluation of thyroid disorder. Patient initially experienced goiter during 1st pregnancy at age 18, followed by hypothyroidism during last pregnancy needing levothyroxine treatment. Due to goiter history, patient underwent work-up by her primary physician in 2021. Thyroid ultrasound (usg) showed bilateral hyperemia, heterogeneous echotexture, and 0.2 cm cystic nodule in the right upper lobe. Labs showed normal TSH 1.33 uIU/ml (0.3-4.0 uIU/ml), normal Free T4 0.99 ng/dl (0.8-1.8 ng/dl), normal total T3 140 ng/dl (71-180 ng/dl). Patient underwent further work-up by endocrinology in 2022. Thyroid ultrasound again revealed bilateral hyperemia with other similar findings. Labs showed normal TSH 2.02uUI/ml, normal free T4 0.93 ng/dl, normal total T3 138 ng/dl. Interestingly, TSI antibody and TPO antibody were significantly elevated at 66.70 IU/L (0.0-0.55 IU/L) and 517 IU/ml (0-34 IU/ml), respectively. Repeat labs in April 2022, again showed normal TSH 1.77 uIU/ml, normal free T4 0.90 ng/dl and normal free T3 2.94 (2.0-4.40 pg/ml). Thyroid uptake scan was not performed due to persistently normal TSH values. Patient denied the use of biotin supplementation. Patient continues to remain clinically and biochemically euthyroid without treatment. CONCLUSION: Our case supports the rare presence of TSI antibody without hyperthyroidism. Close monitoring is warranted due to possibility of future progression to overt hyperthyroidism. REFERENCE: 1. Alvin Mathew A, Papaly R, Maliakal A, et al.(November 10, 2021)Elevated Graves’ Disease-Specific Thyroid-Stimulating Immunoglobulin and Thyroid Stimulating Hormone Receptor Antibody in a Patient With Subacute Thyroiditis. Cureus 13(11): e19448. doi:10.7759/cureus.194482. Vipin Verma, MD, Mc Anto Antony, MD, PSAT346 Persistent Fluctuation Between Hypothyroidism and Hyperthyroidism in a Patient with Both Hashimoto's Thyroiditis and Graves’ Disease: Challenges in Diagnosis and Treatment Approach, Journal of the Endocrine Society, Volume 6, Issue Supplement_1, November-December 2022, Page A833, https://doi.org/10.1210/jendso/bvac150.1723 Presentation Date: Saturday, June 17, 2023

Effects of thermal pretreatment and biotin supplementation on the anaerobic digestion of pineapple (Ananas comosus) wastes, kinetics of methane production, and statistical analysis

The anaerobic digestion (AD) of pineapple wastes (PW) was employed to understand the effects of design parameters, namely thermal pretreatment (TP) temperature (X1) and reaction time (X2), and biotin concentration (X3), to methane production. Kinetic parameters were evaluated by utilizing sigmoidal growth functions, whereas modified Gompertz (MGM) and Logistic function (LF) best described the system among all batch assays. Principal components analysis (PCA) and Pearson correlation matrix were used to understand the correlation and relationship between the design parameters, evaluated kinetic parameters, methane yield (Y), and process performance parameters, wherein it was found that the significantly statistical correlations were Rm-A, λ-X1, A-Y, A-%VS reduction, A-%pH change, Rm-Y, Y-%VS reduction, Y-%pH change, and %VS reduction-%pH change. Furthermore, the cumulative methane production profile in all reactors showed an increase of 19.2–169.2 % in Y compared to the control, suggesting that TP and biotin supplementation were suitable for the optimization of Y from the AD of PW. The Y among all reactors followed the order of A0 <A1 <A2 <A4 <A7 <A3 <A5 <A8 <A6 wherein the lowest Y from pretreated PW was observed at A1 (77.6478 mL/gVS), while the highest was recorded at A6 (175.3053 mL/gVS). The ANOVA results demonstrated that the contribution of main and interaction parameters to Y (X3 >X1X3 >X2X3 >X1 >X2 >X1X2) were statistically significant (p < 0.05), and therefore relevant in the microbial syntrophies during the AD of PW. From the regression analysis, a surrogate mathematical model was constructed with a goodness of fit R2adj= 0.998. Herein, the optimum design conditions in the methane production from AD of PW were found to be X1 = 80ºC, X2 = 120 min, and X3 = 0.25 mg/L.

A population-based study on the common androgenic symptoms in PCOS and its management

The aim of this population-based study is to comprehensively investigate the prevalence, severity, and management of common androgenic symptoms in individuals with Polycystic Ovary Syndrome (PCOS). By analyzing a diverse population sample, this study aims to provide valuable insights into the understanding and effective management of androgenic symptoms associated with PCOS. In the endocrine disorder known a PCOS, the ovaries produce an excessive number of androgens, which are male sex hormones that are typically present in women in modest amounts. The disorder known as polycystic ovarian syndrome is characterized by an abundance of small cysts (fluid-filled sacs) produced by the ovaries. Google forms-based survey data was gathered to better understand recent trends among female patients. In order to understand the pattern of androgenic symptoms in PCOS patients, the obtained replies were examined and analyzed. According to this study, hirsutism, alopecia, and acne are the most typical androgenic symptoms experienced by women. Common treatments for these symptoms include taking biotin supplements, applying minoxidil topically for alopecia, and utilizing over-the-counter acne drugs such benzoyl peroxide and salicylic acid. Additionally, drugs that reduce testosterone are used to treat hirsutism. These results underline how crucial it is to identify and treat androgenic symptoms in women because they can significantly affect both physical appearance and general wellbeing.