Context: To achieve good cure rate during treatment of MDR-TB, strict adherence to treatment regimen is a must. As the second line drugs have great potential to cause adverse drug reactions (ADR), identifying these adverse reactions and treating them early is major factor in preventing default. Hypothyroidism is one such ADR caused by thioamides (ethionamide, prothionamide) and paraamino salicylic acid.Aims: To study the frequency of occurrence of hypothyroidism and its implication in MDR-TB treatment.Settings and design: Retrospective analysis of 488 patients enrolled in our institute for MDR-TB treatment treated with standardised Cat IV treatment, as per RNTCP-PMDT guidelines.Methods and material: Retrospective analysis of 484 (4 had hypothyroidism before treatment initiation) patients treated in our institute was done. Thyroid function test was done at baseline and repeated when indicated by symptoms during clinical follow up. Patients developing hypothyroidism (defined as TSH > 10 microIU/ml) during treatment and the reasons for same are analysed. Its implication in treatment outcome is studied.Results: Out of the 484 study population, 19 (3.9%) had at least one documented record of TSH > 10.0 microIU/ml after treatment initiation. Median time from initiation of MDR-TB treatment to development of hypothyroidism was 153 days (range 32-441 days).Conclusions: Occurrence of hypothyroidism is rare in MDRTB treatment. But symptomatic hypothyroidism is a major factor influencing the patient compliance towards the treatment regimen. As the drugs in regimen are effective in disease treatment, the major hindrance in achieving good cure-rate is to prevent defaulters. Identifying hypothyroidism early helps to prevent default.

Introduction: Tubercular pleural effusion is the second most common extrapulmonary form of tuberculosis in India. Developing nations like India face several health challenges and with limited resources, appropriate planning and channelization of the same is the need of the hour. Material and methods: The objective of the study was to determine the role of cartridge-based nucleic acid amplification test (CBNAAT) in the diagnosis of tubercular pleural effusion (TPE) and also to study if any association exists between CBNAAT and pleural fluid adenosine deaminase (ADA) and lymphocyte counts. Clinically suspected TPE, lymphocyte predominant (≥ 70%) exudates (according to the Lights criteria) with ADA ≥ 40 U/L and microbiologically confirmed pulmonary tuberculosis patients with a co-existent pleural effusion were included. Pleural fluid CBNAAT was performed on all the samples. Results: Out of a total of 75 patients, 57 were males and 18 were females. A lymphocyte predominance of ≥ 70% was seen in 73 subjects (97%). Mean ADA was 61.7 U/L ± 16.2 (SD). Pleural fluid CBNAAT was positive for Mycobacterium tuberculosis (MTB) in 24 patients (32%). Out of these patients, rifampicin resistance was detected in 2 individuals (8.3%). Sputum smear for acid fast bacilli (AFB) was positive in 3 (4%) patients, whereas in sputum CBNAAT MTB was detected in 8 (10.6%) persons. Association between pleural fluid ADA, lymphocyte count and CBNAAT positivity was evaluated by Student T-test. There was a significant association between higher ADA levels and CBNAAT (p value = 0.001). Conclusions: Pleural fluid CBNAAT, owing to its low sensitivity, should not be included in the diagnostic protocol of TPE in high prevalence areas. A high ADA ≥ 40 U/L in combination with Light's criteria to define exudates, with lymphocyte predominance is sufficient evidence to diagnose TPE and initiate anti-tubercular therapy, thereby deferring the need to perform an invasive pleural biopsy.

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