Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field

Abstract

We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment; the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on anti-retroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.

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“…The reported incidence of hypothyroidism in MDR‐TB patients varies greatly from 4% to 69% (Table ). To date, studies have largely investigated the incidence of overt hypothyroidism.…”

“…Interestingly, despite subnormal thyroid hormone levels, TSH levels in our group of participants were not grossly elevated, raising the possibility that non‐specific chronic illness‐associated central suppression of the thyroid axis may have moderated the degree of TSH elevation. A full literature search using MEDLINE and the English language from January 1997 to December 2017 using the search terms ‘multidrug resistant’, ‘tuberculosis’ and ‘hypothyroidism’ identified six prospective cohort studies, two retrospective cohort studies and two case reports reporting thionamide/PAS‐treatment based thyroid outcomes (Table ) . The most recent report is a prospective study that investigated 188 euthyroid individuals undergoing treatment for MDR‐TB in the state of Karnataka, India, over a 6‐month period .…”

“…A full literature search using MEDLINE and the English language from January 1997 to December 2017 using the search terms ‘multidrug resistant’, ‘tuberculosis’ and ‘hypothyroidism’ identified six prospective cohort studies, two retrospective cohort studies and two case reports reporting thionamide/PAS‐treatment based thyroid outcomes (Table ) . The most recent report is a prospective study that investigated 188 euthyroid individuals undergoing treatment for MDR‐TB in the state of Karnataka, India, over a 6‐month period . The authors observed that 23% of individuals developed hypothyroidism, with the majority (74%) occurring after the initial 3 months of therapy.…”

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“…arthralgia, depression, ectodermal dysplasia, psychosis, and xeroderma), and hence may be under-diagnosed. A study in Bangalore reported that prevalence of hypothyroidism during MDR treatment was substantially greater when patients had routine serologic testing as compared to passive detection (23% vs 4%) [33]. Data from this study influenced an update of the guidelines to test every MDR-TB patient for hypothyroidism.…”

“…Compliance with infection control practices in sputum microscopy centres: a study from Kerala, IndiaYes [57]32. Incidence of Drug Induced hypothyroidism during Intensive Phase of treatment for multi drug resistance TB among patients registered under PMDT in Karnataka, IndiaYes [33]33. Will sensitizing qualified private practitioners and Ayurveda medical officers improve symptomatic referral and TB case detection in Bilaspur District, Himachal Pradesh, India?Yes [66]34.…”