Antineutrophil Cytoplasmic Antibody–Positive Small-Vessel Vasculitis Associated with Antithyroid Drug Therapy: How Significant Is the Clinical Problem?

Balavoine, Anne Sophie; Glinoer, Daniel; Dubucquoi, Sylvain; Wémeau, J. L.

doi:10.1089/thy.2014.0603

Cited by 59 publications

(38 citation statements)

References 55 publications

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“…They include drug-induced hepatitis, and the production of cytoplasmic anti-neutrophil antibodies (ANCA). ANCA-positive vasculitis occurs only in exceptional cases, and susceptibility to this condition seems to be higher in patients of Asian origin (26). The risk appears to increase with the duration of PTU therapy, following the opposite pattern to other adverse effects of ATDs, which typically occur during the first 3-6 months of treatment (25,26,27).…”

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

“…ANCA-positive vasculitis occurs only in exceptional cases, and susceptibility to this condition seems to be higher in patients of Asian origin (26). The risk appears to increase with the duration of PTU therapy, following the opposite pattern to other adverse effects of ATDs, which typically occur during the first 3-6 months of treatment (25,26,27). In adults, MMI/CMZ use has also been shown to be associated with ANCA positivity, although the risk for this combination is lower than that reported for PTU (26,28).…”

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

“…The risk appears to increase with the duration of PTU therapy, following the opposite pattern to other adverse effects of ATDs, which typically occur during the first 3-6 months of treatment (25,26,27). In adults, MMI/CMZ use has also been shown to be associated with ANCA positivity, although the risk for this combination is lower than that reported for PTU (26,28). Typical manifestations of ANCA-positive vasculitis are polyarthritis, purpuric skin lesions and occasionally, pulmonary and/or renal involvement.…”

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

“…Typical manifestations of ANCA-positive vasculitis are polyarthritis, purpuric skin lesions and occasionally, pulmonary and/or renal involvement. Discontinuation of the drug generally results in symptom resolution, but glucocorticoids or other immunosuppressive drugs may be required in more severe cases (12,26).…”

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

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MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

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Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

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Section: Monitoring Atd Treatmentmentioning

confidence: 99%

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

Section: Monitoring Atd Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

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“…It has also been shown that AAV can be induced by various drugs, for example by the thyroid drug propylthiouracil (PTU). Over 20% of patients with Graves' disease treated with PTU develop MPO-ANCA and some of them also an AAV-like disease (Wada et al 2002, Balavoine et al 2015.…”

Section: Environmental Risk Factorsmentioning

confidence: 99%

The Contribution of Innate Immunity to the Pathogenesis of ANCA-associated Vasculitis

Söderberg¹

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"Nog finns det mål och mening med vår färd -men det är vägen som är mödan värd" − Karin Boye SupervisorMårten Segelmark, Linköping University, Sweden Co-supervisorsPer Eriksson, Linköping University, Sweden Jan Ernerudh, Linköping University, Sweden Tino Kurz, Linköping University, Sweden Faculty opponentPeter Heeringa, University of Groningen, The Netherlands Abstract Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitute a group of vasculitides characterized by neutrophil-rich necrotizing inflammation of small vessels and the presence of ANCA in the circulation. Dying neutrophils surrounding the walls of small vessels are a histological hallmark of AAV. Traditionally it has been assumed that these neutrophils die by necrosis, but neutrophil extracellular traps (NETs) have recently been visualized at the sites of vasculitic lesions. NETs were first described to be involved in capture and elimination of pathogens but dysregulated production and/or clearance of NETs are thought to contribute to vessel inflammation in AAV; directly by damaging endothelial cells and indirectly by acting as a link between the innate and adaptive immune system through the generation of pathogenic PR3-ANCA and MPO-ANCA that can activate neutrophils. ANCA can, however, be found in all individuals and are therefore suggested to belong to the repertoire of natural antibodies produced by innate-like B cells, implying that not all ANCA are pathogenic.In paper I, we found neutrophils in patients to be more prone to undergo NETosis/necrosis spontaneously compared with neutrophils in healthy controls (HC), as well as that active patients possessed elevated levels of NETs in the circulation. Our results also suggest that ANCA during remission could contribute to the clearance of NETs as we observed an inverse relation between ANCA and NETs. In paper II, we observed neutrophils in patients to be more easily activated upon ANCA stimulation as they produced more ROS than neutrophils in HC. In paper III, we showed for the first time that cells of adaptive immunity (B and T cells)

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Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Antineutrophil Cytoplasmic Antibody–Positive Small-Vessel Vasculitis Associated with Antithyroid Drug Therapy: How Significant Is the Clinical Problem?

Cited by 59 publications

References 55 publications

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

The Contribution of Innate Immunity to the Pathogenesis of ANCA-associated Vasculitis

Hyperthyroidism

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