Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field.
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.
Drug Resistant Treatment Centre, Bengaluru, India; Sri Devarao Shivaram, Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India.
Somashekar
S
Munivenkatappa
Revised National Tuberculosis Programme-State of Karnataka, Bengaluru, India.
Singarajipura
S
Anil
World Health Organization, India Country Office, New Delhi, India.
Balaji
B
Naik
U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Tyson
T
Volkmann
International Union against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Karuna D
KD
Sagili
Sri Devarao Shivaram, Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India.
Jayachamarajapura S
JS
Akshatha
Sri Devarao Shivaram, Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India.
Shashidhar
S
Buggi
National Tuberculosis Institute, Bengaluru, India.
Manchenahalli A
MA
Sharada
Drug Resistant Treatment Centre, Bengaluru, India.
Sudhendra
S
Kulkarni
National Tuberculosis Institute, Bengaluru, India.
Vineet K
VK
Chadha
U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Patrick K
PK
Moonan
Hypothyroidism; India; Multidrug Resistance; Thyroid-Stimulating Hormone; Tuberculosis