High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients

黃 萬均(Wan-Chun Huang), 黃 晟維(Cheng-Wei Huang), 徐 克明(Ko-Ming Hsu), 簡 慎萱(Shen-Hsuan Chien), 余 明治(Ming-Chih Yu)

Research output: Contribution to journalArticle

Abstract

Background: Hypothyroidism is a known adverse effect of treatment for multidrug-resistant tuberculosis (MDR-TB). It has been suspected to be rare; however, recent studies report an incidence ranging from 3.5% to 71.4%. Development of hypothyroidism is considered to be attributed to the administration of prothionamide, ethionamide, and p-aminosalicylic acid, but whether a combination of these drugs influences this development is not known. The present study retrospectively analyzed the incidence of hypothyroidism in patients treated for MDR-TB and the correlation with these drugs. Methods: The records of 50 patients treated for MDR-TB from January 1, 2009 to March 31, 2012 were retrospectively analyzed. All patients were followed until completion of treatment, or until March 31, 2012. Data regarding patient characteristics, co-morbidities, baseline blood test and thyroid function test results, administration of prothionamide and p-aminosalicylic acid, and thyroid-stimulation hormone (TSH) levels during treatment were extracted for analysis. Results: Twenty-four (48%) of the 50 patients developed hypothyroidism. The median and mean times from start of treatment to detection of hypothyroidism were 151 days and 162 days, respectively. Patients who developed hypothyroidism were significantly younger (p=0.045) than those who did not. Prothionamide and p-aminosalicylic acid were found to be associated with hypothyroidism development. The combination of these 2 drugs was associated with a higher risk of developing hypothyroidism (odds ratio=4.385, p=0.03) than the use of prothionamide alone. Conclusion: Hypothyroidism is relatively common in patients treated for MDR-TB. The incidence is higher in patients receiving a combination of prothionamide and p-aminosalicylic acid. Clinicians should be aware of this possible adverse effect, and watch for clinical symptoms and signs suggesting hypothyroidism, especially in young patients and during the first few months of treatment. Beginning TSH testing as early as 1 month after beginning treatment may be appropriate.
Original languageEnglish
Pages (from-to)209-217
Number of pages9
Journal胸腔醫學
Volume29
Issue number4
Publication statusPublished - 2014

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Multidrug-Resistant Tuberculosis
Hypothyroidism
Prothionamide
Aminosalicylic Acid
Incidence
Therapeutics
Drug Combinations
Thyroid Hormones
Ethionamide
Thyroid Function Tests
Hematologic Tests
Signs and Symptoms
Cohort Studies
Odds Ratio
Morbidity

Keywords

  • 多重抗藥性結核
  • 甲狀腺功能低下症
  • 丙硫異煙胺
  • 對氨基水楊酸
  • multidrug-resistant tuberculosis
  • hypothyroidism
  • prothionamide
  • p-aminosalicylic acid

Cite this

黃萬均(Wan-Chun H, 黃晟維(Cheng-Wei H, 徐克明(Ko-Ming H, 簡慎萱(Shen-Hsuan C, & 余明治(Ming-Chih Y (2014). High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients. 胸腔醫學, 29(4), 209-217.

High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients. / 黃萬均(Wan-Chun Huang); 黃晟維(Cheng-Wei Huang); 徐克明(Ko-Ming Hsu); 簡慎萱(Shen-Hsuan Chien); 余明治(Ming-Chih Yu).

In: 胸腔醫學, Vol. 29, No. 4, 2014, p. 209-217.

Research output: Contribution to journalArticle

黃萬均(Wan-ChunH, 黃晟維(Cheng-WeiH, 徐克明(Ko-MingH, 簡慎萱(Shen-HsuanC & 余明治(Ming-ChihY 2014, 'High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients', 胸腔醫學, vol. 29, no. 4, pp. 209-217.
黃萬均(Wan-ChunH, 黃晟維(Cheng-WeiH, 徐克明(Ko-MingH, 簡慎萱(Shen-HsuanC, 余明治(Ming-ChihY. High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients. 胸腔醫學. 2014;29(4):209-217.
黃萬均(Wan-Chun Huang) ; 黃晟維(Cheng-Wei Huang) ; 徐克明(Ko-Ming Hsu) ; 簡慎萱(Shen-Hsuan Chien) ; 余明治(Ming-Chih Yu). / High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients. In: 胸腔醫學. 2014 ; Vol. 29, No. 4. pp. 209-217.
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title = "High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients",
abstract = "Background: Hypothyroidism is a known adverse effect of treatment for multidrug-resistant tuberculosis (MDR-TB). It has been suspected to be rare; however, recent studies report an incidence ranging from 3.5{\%} to 71.4{\%}. Development of hypothyroidism is considered to be attributed to the administration of prothionamide, ethionamide, and p-aminosalicylic acid, but whether a combination of these drugs influences this development is not known. The present study retrospectively analyzed the incidence of hypothyroidism in patients treated for MDR-TB and the correlation with these drugs. Methods: The records of 50 patients treated for MDR-TB from January 1, 2009 to March 31, 2012 were retrospectively analyzed. All patients were followed until completion of treatment, or until March 31, 2012. Data regarding patient characteristics, co-morbidities, baseline blood test and thyroid function test results, administration of prothionamide and p-aminosalicylic acid, and thyroid-stimulation hormone (TSH) levels during treatment were extracted for analysis. Results: Twenty-four (48{\%}) of the 50 patients developed hypothyroidism. The median and mean times from start of treatment to detection of hypothyroidism were 151 days and 162 days, respectively. Patients who developed hypothyroidism were significantly younger (p=0.045) than those who did not. Prothionamide and p-aminosalicylic acid were found to be associated with hypothyroidism development. The combination of these 2 drugs was associated with a higher risk of developing hypothyroidism (odds ratio=4.385, p=0.03) than the use of prothionamide alone. Conclusion: Hypothyroidism is relatively common in patients treated for MDR-TB. The incidence is higher in patients receiving a combination of prothionamide and p-aminosalicylic acid. Clinicians should be aware of this possible adverse effect, and watch for clinical symptoms and signs suggesting hypothyroidism, especially in young patients and during the first few months of treatment. Beginning TSH testing as early as 1 month after beginning treatment may be appropriate.",
keywords = "多重抗藥性結核, 甲狀腺功能低下症, 丙硫異煙胺, 對氨基水楊酸, multidrug-resistant tuberculosis, hypothyroidism, prothionamide, p-aminosalicylic acid, 多重抗藥性結核, 甲狀腺功能低下症, 丙硫異煙胺, 對氨基水楊酸, multidrug-resistant tuberculosis, hypothyroidism, prothionamide, p-aminosalicylic acid",
author = "黃, {萬均(Wan-Chun Huang)} and 黃, {晟維(Cheng-Wei Huang)} and 徐, {克明(Ko-Ming Hsu)} and 簡, {慎萱(Shen-Hsuan Chien)} and 余, {明治(Ming-Chih Yu)}",
year = "2014",
language = "English",
volume = "29",
pages = "209--217",
journal = "胸腔醫學",
issn = "1023-9855",
publisher = "臺灣胸腔暨重症加護醫學會",
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TY - JOUR

T1 - High Incidence of Treatment-Related Hypothyroidism in Multidrug-Resistant Tuberculosis Patients

AU - 黃, 萬均(Wan-Chun Huang)

AU - 黃, 晟維(Cheng-Wei Huang)

AU - 徐, 克明(Ko-Ming Hsu)

AU - 簡, 慎萱(Shen-Hsuan Chien)

AU - 余, 明治(Ming-Chih Yu)

PY - 2014

Y1 - 2014

N2 - Background: Hypothyroidism is a known adverse effect of treatment for multidrug-resistant tuberculosis (MDR-TB). It has been suspected to be rare; however, recent studies report an incidence ranging from 3.5% to 71.4%. Development of hypothyroidism is considered to be attributed to the administration of prothionamide, ethionamide, and p-aminosalicylic acid, but whether a combination of these drugs influences this development is not known. The present study retrospectively analyzed the incidence of hypothyroidism in patients treated for MDR-TB and the correlation with these drugs. Methods: The records of 50 patients treated for MDR-TB from January 1, 2009 to March 31, 2012 were retrospectively analyzed. All patients were followed until completion of treatment, or until March 31, 2012. Data regarding patient characteristics, co-morbidities, baseline blood test and thyroid function test results, administration of prothionamide and p-aminosalicylic acid, and thyroid-stimulation hormone (TSH) levels during treatment were extracted for analysis. Results: Twenty-four (48%) of the 50 patients developed hypothyroidism. The median and mean times from start of treatment to detection of hypothyroidism were 151 days and 162 days, respectively. Patients who developed hypothyroidism were significantly younger (p=0.045) than those who did not. Prothionamide and p-aminosalicylic acid were found to be associated with hypothyroidism development. The combination of these 2 drugs was associated with a higher risk of developing hypothyroidism (odds ratio=4.385, p=0.03) than the use of prothionamide alone. Conclusion: Hypothyroidism is relatively common in patients treated for MDR-TB. The incidence is higher in patients receiving a combination of prothionamide and p-aminosalicylic acid. Clinicians should be aware of this possible adverse effect, and watch for clinical symptoms and signs suggesting hypothyroidism, especially in young patients and during the first few months of treatment. Beginning TSH testing as early as 1 month after beginning treatment may be appropriate.

AB - Background: Hypothyroidism is a known adverse effect of treatment for multidrug-resistant tuberculosis (MDR-TB). It has been suspected to be rare; however, recent studies report an incidence ranging from 3.5% to 71.4%. Development of hypothyroidism is considered to be attributed to the administration of prothionamide, ethionamide, and p-aminosalicylic acid, but whether a combination of these drugs influences this development is not known. The present study retrospectively analyzed the incidence of hypothyroidism in patients treated for MDR-TB and the correlation with these drugs. Methods: The records of 50 patients treated for MDR-TB from January 1, 2009 to March 31, 2012 were retrospectively analyzed. All patients were followed until completion of treatment, or until March 31, 2012. Data regarding patient characteristics, co-morbidities, baseline blood test and thyroid function test results, administration of prothionamide and p-aminosalicylic acid, and thyroid-stimulation hormone (TSH) levels during treatment were extracted for analysis. Results: Twenty-four (48%) of the 50 patients developed hypothyroidism. The median and mean times from start of treatment to detection of hypothyroidism were 151 days and 162 days, respectively. Patients who developed hypothyroidism were significantly younger (p=0.045) than those who did not. Prothionamide and p-aminosalicylic acid were found to be associated with hypothyroidism development. The combination of these 2 drugs was associated with a higher risk of developing hypothyroidism (odds ratio=4.385, p=0.03) than the use of prothionamide alone. Conclusion: Hypothyroidism is relatively common in patients treated for MDR-TB. The incidence is higher in patients receiving a combination of prothionamide and p-aminosalicylic acid. Clinicians should be aware of this possible adverse effect, and watch for clinical symptoms and signs suggesting hypothyroidism, especially in young patients and during the first few months of treatment. Beginning TSH testing as early as 1 month after beginning treatment may be appropriate.

KW - 多重抗藥性結核

KW - 甲狀腺功能低下症

KW - 丙硫異煙胺

KW - 對氨基水楊酸

KW - multidrug-resistant tuberculosis

KW - hypothyroidism

KW - prothionamide

KW - p-aminosalicylic acid

KW - 多重抗藥性結核

KW - 甲狀腺功能低下症

KW - 丙硫異煙胺

KW - 對氨基水楊酸

KW - multidrug-resistant tuberculosis

KW - hypothyroidism

KW - prothionamide

KW - p-aminosalicylic acid

M3 - Article

VL - 29

SP - 209

EP - 217

JO - 胸腔醫學

JF - 胸腔醫學

SN - 1023-9855

IS - 4

ER -