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Rifampin, an antituberculosis drug, can cause hypothyroidism in patients with Hashimoto’s thyroiditis
The background of the study. Some drugs accelerate
the clearance of thyroxine (T4) from the bloodstream. They include
rifampin, which is used to treat tuberculosis, and phenytoin and
carbamazepine, which are used to treated epilepsy. In most people
treated with these drugs, thyroid secretion increases sufficiently
to maintain normal serum T4 concentrations. However, it may not
increase in patients with thyroid disease. This article describes
three patients with Hashimoto’s thyroiditis in whom treatment
with rifampin was associated with hypothyroidism.
Case 1. A 62-year-old man was hospitalized because of cough. His serum thyrotropin (TSH) concentration was normal, but he had high serum antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibody concentrations. He was found to have pulmonary tuberculosis, and was treated with rifampin. Two weeks later, his serum TSH concentration was high (170 mU/L) and his serum T4 concentration was low. He was treated with T4. After rifampin was stopped, T4 was stopped, and he remained well.
Case 2. A 66-year-old woman was found to have abdominal tuberculosis. She was euthyroid, but had a goiter and high serum anti-TPO and anti-Tg antibody concentrations. She was treated with rifampin, and hypothyroidism developed (serum TSH, 12.5 mU/L). She was treated with T4 until the rifampin was stopped, and remained euthyroid thereafter.
Case 3. A 56-year-old woman with a liver abscess and enlarged lymph nodes had a lymph-node biopsy that revealed tuberculosis. She was euthyroid, but had a goiter and had a high serum anti-Tg antibody concentration. She was treated with rifampin; two weeks later her serum TSH concentration was high (21.3 mU/L), and she was treated with T4. She remained euthyroid after both were stopped. Later, rifampin was resumed, and she again had hypothyroidism and was treated with T4. Both were later stopped, and she remained euthyroid.
The conclusions of the study. In patients with Hashimoto’s thyroiditis, the antituberculosis drug rifampin can cause reversible hypothyroidism.
The original article. Takasu N, Takara M, Komiya I. Rifampin-induced hypothyroidism in patients with Hashimoto’s thyroiditis. N Engl J Med 2005;352:518-9.
Next Article: Children with vitamin
A and iodine deficiency have less severe hypothyroidism and
more goiter than those with iodine deficiency alone |
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| Thyroid Digest Index | | | March 2005 Thyroid Digest |
