Possible induction of Graves' disease and painless thyroiditis by gonadotropin-releasing hormone analogues.
Prolonged administration of gonadotropin-releasing hormone (GnRH) analogues induce a decrease in serum estrogen level, which may aggravate subclinical or mild autoimmune thyroid disease. Two patients developed Graves' thyrotoxicosis in association with an increase in anti-thyrotropin (TSH) receptor antibody activities at 4 months after initiation of buserelin acetate. GnRH analogue therapy was discontinued at the time of diagnosis but it took more than 2 years of methimazole therapy to obtain remission of Graves' disease. Another patient developed painless thyroiditis in association with an increase in antithyroid microsomal antibodies at 4 months after initiation of leuprolide acetate. These results indicate that GnRH analogues possibly induce clinical onset of Graves' thyrotoxicosis or destruction-induced thyrotoxicosis. Clinicians should be aware of this phenomenon. All patients who are to receive GnRH analogue therapy should be examined for antithyroid antibodies and family history of autoimmune thyroid disease, and should be followed accordingly.
Amino
Nobuyuki
N
Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. namino@labo.med.osaka-u.ac.jp
Hidaka
Yoh
Y
Takano
Toru
T
Tatsumi
Ke-ita
KI
Izumi
Yukiko
Y
Nakata
Yukiko
Y
D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006111:Graves Disease / Q000139:chemically induced*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D008875:Middle Aged; D010146:Pain; D013966:Thyroiditis / Q000139:chemically induced* / Q000503:physiopathology; D013967:Thyroiditis, Autoimmune / Q000139:chemically induced; D013972:Thyrotropin / Q000097:blood / Q000276:immunology; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
D018828:Immunoglobulins, Thyroid-Stimulating; D014284:Triiodothyronine; D007987:Gonadotropin-Releasing Hormone; D013972:Thyrotropin; D013974:Thyroxine