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CPE-001 · synthetic case FX-012
Biotin use with discordant apparent thyrotoxicosis labs
Low TSH, high FT4, and a daily biotin supplement.
Purpose: Surface assay interference review.
Inputs the engine received
Patient
- Age and sex
- 40, female
Medications
- Biotin supplement
- Yes
Laboratory
- TSH
- 0.03 mIU/L (ref 0.4–4.5)
- FT4
- 2.1 ng/dL (ref 0.8–1.8)
What the engine reports
Thyrotoxicosis requires etiologic differentiation. Positive Anti-TPO alone does not distinguish Graves disease from destructive thyroiditis. Review TRAb/TSI and additional evaluation when clinically appropriate.
Interpretation Caution
Possible analytical interference identified. Biotin or assay-related effects may alter thyroid results. Confirm or repeat testing when clinically appropriate before final classification.
Detected clinical pattern
Thyrotoxicosis Pattern — Etiology Requires Differentiation
Low/suppressed TSH with elevated FT4 and/or T3; Graves disease and destructive thyroiditis require appropriate differentiation.
Why this pattern was identified
- Suppressed TSH with high thyroid hormone. TSH 0.03 mIU/L (ref 0.4–4.5) with FT4 2.1 ng/dL (ref 0.8–1.8).
Context modules routed
CTX-HT-ASSAY Analytical Interference and Discordant Results
Review supplements, biotin exposure and assay/platform issues; repeat or confirm testing before classifying atypical patterns when clinically safe.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Evaluate Graves disease versus destructive thyroiditis using clinical context and TRAb/TSI when appropriate.
- 2Consider imaging or uptake assessment only when clinically appropriate and not contraindicated by pregnancy or lactation.
Differentials, pitfalls and contradicting signals
- Graves disease
- Destructive (painless, subacute or postpartum) thyroiditis
- Exogenous thyroid hormone or assay interference
- Biotin can falsely lower TSH and raise FT4 in some immunoassays; confirm or repeat testing before final classification.
Evidence and rule trace · 2 rules
PR-HT-05Thyrotoxicosis with Autoimmune Marker — Etiology Not Yet Classified
Inputs: TSH 0.03 mIU/L (ref 0.4–4.5) · FT4 2.1 ng/dL (ref 0.8–1.8)
Thyrotoxicosis pattern; Graves disease versus destructive thyroiditis not yet differentiated.
CTX-HT-ASSAYAnalytical Interference and Discordant Results
Context module routed.
Evidence
- EV-ATA-THYROIDITIS · American Thyroid Association. Thyroiditis.
Physician adjudication required. For clinician review only. This output identifies clinical patterns and safety considerations from the documented inputs. It does not establish an autonomous diagnosis or treatment plan. Physician confirmation is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Thyroid-function testsMove the sliders or type values
- below range
- within range
- above range
- below range
- within range
- above range
Zones are drawn from your reference intervals. The engine, not the map, decides the pattern.
Laboratory values and reference rangesUse your lab's own interval
µIU/mL and mIU/L are numerically identical.
Interpreted against the reporting assay's upper limit.
Only used in the thyrotoxicosis pathway.
Patient context
Medications and exposures
Symptoms and physical findingsSupportive only: never classify on their own
Symptoms
Signs and decompensation red flags
More thyroid cases
FX-001
Overt primary hypothyroidism with autoimmune support
A 54-year-old with fatigue, cold intolerance and a TSH of 18.4.
FX-002
Antibody positive with euthyroid function
Strongly positive antibodies, but TSH and FT4 are both normal.
FX-003
Mild subclinical pattern with positive Anti-TPO
Mildly high TSH, normal FT4, positive Anti-TPO.
FX-004
TSH at or above 10 with normal FT4
TSH of 12 with a normal FT4 in a woman of 57.
FX-005
Pregnancy context with mild TSH elevation and Anti-TPO positivity
Pregnant, TSH 3.1 against a pregnancy range, Anti-TPO positive.
FX-006
Preconception infertility context
Trying to conceive, TSH 4.8, Anti-TPO positive.
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