Rifampicin
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Rifampicin Hypothyroidism: case report A 34-year-old woman developed hypothyroidism during treatment with rifampicin for miliary tuberculosis. The woman was hospitalised and started receiving rifampicin 0.45g [frequency not stated], isoniazid, ethambutol and pyrazinamide; before antitubercular initiation, her serum thyroid-stimulating hormone (TSH) and free thyroxine levels were 1.7 µIU/mL and 1.3 ng/dL, respectively. Two weeks after antitubercular initiation, she developed general weakness, muscle pain and periorbital oedema. At this time, she had the following levels: TSH > 100 µIU/mL, free thyroxine 0.45 ng/dL, triiodothyronine 36.7 ng/dL, antimicrosomal antibody 12.5 U/mL and antithyroglobulin antibody 22.8 U/mL. The woman started receiving levothyroxine sodium and, 2 weeks later, her TSH, free thyroxine and triiodothyronine levels were > 100 µIU/mL, 0.51 ng/dL and 49.7 ng/dL, respectively, and her levothyroxine sodium dose was increased. However, both rifampicin and levothyroxine sodium were subsequently discontinued on suspicion of rifampicin-induced hypothyroidism. Her thyroid function showed improvement, but did not return to normal. Levothyroxine was then restarted and, after 1 month, she became euthyroid. Rifampicin was then restarted due to worsening of the woman’s lung lesion. She again developed hypothyroidism and her levothyroxine dose was increased. After 9 months, her tuberculosis had improved and antituberculars were discontinued, but levothyroxine sodium was continued for 2 more months at a reduced dose and then discontinued. At the last follow-up, her TSH, free thyroxine and triiodothyronine levels were 1.94 µIU/mL, 1.68 ng/dL and 90.0 ng/dL, respectively. Author comment: The patient, who was euthyroid during treatment with levothyroxine, isoniazid, ethambutol and pyrazinamide, became hypothyroid after rifampicin initiation. "This demonstrates that [rifampicin] can induce hypothyroidism in euthyroid persons and aggravate hypothyroidism in hypothyroid patients." KIM D-L, et al. Rifampin-induced hypothyroidism without underlying thyroid 801091870 disease. Thyroid 17: 793-795, No. 8, Aug 2007 - South Korea
0114-9954/10/1175-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 27 Oct 2007 No. 1175
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