High rate of hypothyroidism among patients treated for multidrug-resistant tuberculosis in Lesotho.
BACKGROUND
Hypothyroidism is a known side effect of treatment for multidrug-resistant tuberculosis (MDR-TB), but it is considered to be rare. Hypothyroidism has vague and non-specific symptoms, and can be easily missed by clinicians.


OBJECTIVE
To report the high rate of hypothyroidism  in a cohort of MDR-TB patients in Lesotho and to describe our approach to diagnosis and management.


METHODS
A retrospective study of 212 patients who initiated treatment for MDR-TB in Lesotho between 27 July 2007 and 24 March 2009 was performed.


RESULTS
Among 186 patients screened,  129 (69%) had hypothyroidism, defined as at least one documented thyroid-stimulating hormone (TSH) result > 10.0 mIU/l; 100 (54%) patients had a maximum TSH > 20.0 mIU/l. At 93 days after starting MDR-TB treatment, half of the patients had developed hypothyroidism.


CONCLUSIONS
Hypothyroidism  may be more common during MDR-TB treatment than previously recognized. Screening all patients, even those without symptoms, for hypothyroidism within 2-3 months of starting MDR-TB treatment should be considered until prospective studies can inform screening guidelines.
Partners In Health Lesotho, Maseru, Lesotho. hsatti@pih.org
H
H
Satti
A
A
Mafukidze
P L
PL
Jooste
M M
MM
McLaughlin
P E
PE
Farmer
K J
KJ
Seung
D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced*; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013972:Thyrotropin / Q000097:blood*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
D000995:Antitubercular Agents; D013972:Thyrotropin