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Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 131-133

Induction of hypothyroidism in Hashimoto's thyroiditis during leprosy treatment


Department of Clinical and Epidemiology Division, Central Leprosy Teaching and Research Institute, Ministry of Health and Family Welfare, Government of India, Chengalpattu, Tamil Nadu, India

Date of Web Publication31-Dec-2015

Correspondence Address:
Pugazhenthan Thangaraju
OIC Laboratory Division, Chengalpattu - 603 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-4220.172913

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  Abstract 

We report a female case who developed hypothyroid in the course of multibacillary multidrug therapy regimen for leprosy. The evaluation was made to rule out the possible cause of rifampicin induced hypothyroidism in Hashimoto's thyroiditis.

Keywords: Hashimotos thyroiditis, hypothyroid, rifampicin, thyroxine


How to cite this article:
Thangaraju P, Singh H, Punitha M, Giri V C, Ali S. Induction of hypothyroidism in Hashimoto's thyroiditis during leprosy treatment. Int J Adv Med Health Res 2015;2:131-3

How to cite this URL:
Thangaraju P, Singh H, Punitha M, Giri V C, Ali S. Induction of hypothyroidism in Hashimoto's thyroiditis during leprosy treatment. Int J Adv Med Health Res [serial online] 2015 [cited 2021 Sep 26];2:131-3. Available from: https://www.ijamhrjournal.org/text.asp?2015/2/2/131/172913


  Introduction Top


Hashimoto's thyroiditis is an autoimmune thyroid disease, which is organ-specific characterized by diffuse goiter with lymphocytic infiltration and the presence of organ-specific autoantibodies. As of now, it is one of the most prevalent disorders of the thyroid and a cause of hypothyroidism in dietary iodine sufficient areas. The prevalence of positive antibody tests in women is >10% and of clinical disease, at least 2%. [1] Men have one tenth of this prevalence. Hashimoto's thyroiditis is thought to arise from an interaction between various genetic susceptibility, effect of epigenes and the environmental triggers (e.g., minerals iodine, infection). [2]

Clinical diagnosis of Hashimoto's thyroiditis is based on the presence of diffuse goiter, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies or lymphocytic infiltration on histopathological examination. However, various clinical spectrums have reportedly occurred, including euthyroidism with goiter, a subclinical hypothyroidism with goiter, established hypothyroidism, painless, silent thyroiditis, postpartum painless thyroiditis, and alternating hypothyroidism and hyperthyroidism.

Painless thyroiditis is very well-characterized by transient thyrotoxic phase with no symptoms of anterior neck pain or sign of tenderness, this latter change from euthyroidism to hypothyroidism and reverting to euthyroidism. [3] Postpartum silent thyroiditis occurs within 6 months after delivery. An immune rebound mechanism might mediate induction of silent thyroiditis with transient autoimmune phenomena. [3]

Few drugs as an intraction can affect thyroid function. [4] The different levels at which various pharmacological agents can affect thyroid hormone functions are by varying levels of binding proteins or by competing for their hormone binding sites or synthesis or secretion or altering thyroid hormone metabolism and cellular uptake or by interfering hormone action at the targeted tissue level. [5]


  Case Report Top


A 40-year-old female was referred from district Urban Leprosy Centre to CLTRI, Chengalpattu. The patient presented with a complaint of weakness of fourth and fifth finger of the right hand. At the time of referral, the patient was getting her eighth pulse of multibacillary multidrug therapy. On clinical and physiological nerve assessment, involvement of the ulnar nerve was diagnosed and was prescribed a steroid for neuritis. She was advised to continue the rest of the regimen from CLTRI. The patient visited CLTRI after 15 days with the complaints of diffuse neck swelling and difficulty in swallowing. Hence, thyroid profile was done for the patient. The report was consistent with hypothyroid values with autoantibodies positive for thyroglobulin and microsomes which suggest Hashimoto's thyroiditis [Table 1]. A detailed past history also showed that the patient was diagnosed Hashimotos thyroiditis with normal hormonal values during February 2012 [Table 2]. The patient was started with l-thyroxine 100 mg for the hypothyroid. The patient was allowed to continue the rest of the pulses and simultaneously the thyroid medication. Once the patient was released from the treatment, the thyroid status was once again verified by temporarily stopping the thyroxine, to rule out possible causes of hypothyroid due to rifampicin. However, the patient did not revert to euthyroid after removing the influencing drug rifampicin [Table 2].
Table 1: Laboratory and imaging investigations

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Table 2: Thyroid values at various time points

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  Discussion Top


This case alerts the lepralogist regarding the influence of rifampicin over the thyroid status in female having autoimmune thyroiditis. Shuji et al. showed the influence of rifampicin over the thyroid status in Hashimoto's thyroiditis in patients treated with anti-tuberculosis regimen. Hypothyroidism developed within 2 weeks of administration of rifampicin in the tubercular patients, but resolved in each, once rifampicin was discontinued. [6] The possible cause for the development of hypothyroidism within 2 weeks of rifampicin administration, might be because of, the large doses of rifampicin used in anti-tuberculosis treatment regimen (six doses of rifampicin 600 mg as per DOTS within 2 weeks). However, in our case, the eight dosages of rifampicin took approximately 8 months for the development of the hypothyroid state. Cytochrome P450 complex (CYP3A) consists of enzymes responsible for oxidative and reducing reactions. Some of these enzymes are induced by rifampicin. This can produce marked reductions in thyroid hormone levels in the serum. The mechanism behind the hypothyroid state development is rifampicin increases T4 clearance because of enhanced hepatic T4 metabolism and biliary excretion of iodothyronine conjugates. [7],[8] Studies in normal volunteers indicate that drug rifampicin decreases circulating thyroid hormone levels without affecting another protein of thyroid glandthyrotropin, [9] suggesting that rifampicin has a direct downward effect on thyroid hormone status.

With this background, our case was evaluated for the possible influence of rifampicin. It was found from the evaluation that, rifampicin might precipitate hypothyroidism much earlier than, what is supposed to occur in the natural progression of the disease.

 
  References Top

1.
Akamizu T, Amino N, DeGroot LJ. Hashimoto's thyroiditis. In: Thyroid Disease Manager; 2012. Available from: http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/. [Last acessed on 2015 May 11].  Back to cited text no. 1
    
2.
Hasham A, Tomer Y. Genetic and epigenetic mechanisms in thyroid autoimmunity. Immunol Res 2012;54:204-13.  Back to cited text no. 2
    
3.
Amino N, Tada H, Hidaka Y. Postpartum autoimmune thyroid syndrome: A model of aggravation of autoimmune disease. Thyroid 1999;9:705-13.  Back to cited text no. 3
    
4.
Haugen BR. Drugs that suppress TSH or cause central hypothyroidism. Best Pract Res Clin Endocrinol Metab 2009;23:793-800.  Back to cited text no. 4
    
5.
Saikia UK, Saikia M. Drug-induced thyroid disorders. J Indian Med Assoc 2006;104:583, 585-7, 600.  Back to cited text no. 5
    
6.
Shuji F, Gregory AB, Masahiro S. Rifampin-induced hypothyroidism in patients with Hashimoto's thyroiditis. New Engl J Med 2005;352:5.  Back to cited text no. 6
    
7.
Ohnhaus EE, Bürgi H, Burger A, Studer H. The effect of antipyrine, phenobarbitol and rifampicin on thyroid hormone metabolism in man. Eur J Clin Invest 1981;11:381-7.  Back to cited text no. 7
    
8.
Finke C, Juge C, Goumaz M, Kaiser O, Davies R, Burger AG. Effects of rifampicin on the peripheral turnover kinetics of thyroid hormones in mice and in men. J Endocrinol Invest 1987;10:157-62.  Back to cited text no. 8
    
9.
Ohnhaus EE, Studer H. A link between liver microsomal enzyme activity and thyroid hormone metabolism in man. Br J Clin Pharmacol 1983;15:71-6.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]



 

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