Hypothyroidism associated with therapy for multi-drug-resistant tuberculosis in Australia.

2019-03

Cheung, Yee-Ming Melody

Van, Karen

Lan, Lan

Barmanray, Rahul

Qian, Sarah Y

Shi, William Y

Wong, Jennifer L A

Hamblin, Peter S

Colman, Peter G

Topliss, Duncan J

Denholm, Justin T

Grossmann, Mathis

drug resistance

drug-related side-effects and adverse reactions

thyroid disease

tuberculosis

Journal Article

0000-0003-3875-5698

0000-0003-1224-6908

0000-0002-1433-2239

0000-0002-4304-8333

0000-0002-9214-6431

0000-0001-8261-3457

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#PLACEHOLDER_PARENT_METADATA_VALUE#

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10.1111/imj.14085

Reports from resource-poor countries have associated thionamide- and para-aminosalicylate sodium (PAS)-based treatment of multi-drug-resistant tuberculosis (MDR-TB) with the development of hypothyroidism. To identify predictors and assess the cumulative proportions of hypothyroidism in patients treated for MDR-TB with these agents in Australia. Retrospective multicentre study of MDR-TB patients from five academic centres covering tuberculosis (TB) services in Victoria, Australia. Patients were identified using each centre's pharmacy department and cross checked with the Victorian Tuberculosis Program. Hypothyroidism was categorised as subclinical if the thyroid-stimulating hormone was elevated and as overt if free thyroxine (fT4) was additionally reduced on two separate occasions. Our main outcome measured was the cumulative proportion of hypothyroidism (at 5 years from treatment initiation). Of the 29 cases available for analysis, the cumulative proportion of hypothyroidism at 5 years was 37% (95% confidence interval (CI): 0-57.8%). Eight of the nine affected cases developed hypothyroidism within the first 12 months of treatment. Hypothyroidism was marginally (P = 0.06) associated with higher prothionamide/PAS dosing and was reversible with cessation of the anti-tuberculosis medication. Prothionamide/PAS treatment-associated hypothyroidism is common in MDR-TB patients in Australia, emphasising the importance of regular thyroid function monitoring during this treatment. Thyroid hormone replacement, if initiated, may not need to be continued after MDR-TB treatment is completed.

link

Internal Medicine Journal 2019; 49(3): 364-372

Internal Medicine Journal