ethionamide and Hypothyroidism

Hypothyroidism is one of the adverse drug reactions that associated with Multidrug Resistant Tuberculosis (MDR-TB) medications. Extremely variable magnitude of hypothyroidism in MDR-TB patients has been reported from different parts of the world. However, there is no evidence that tried to estimate the pooled prevalence of hypothyroidism to confirm the rareness of hypothyroidism in MDR-TB patients on treatment. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of hypothyroidism in MDR-TB patients on treatment, and to summarize the demographic and clinical characteristics of the patients.. We conducted a systematic review and meta-analysis on studies reported around the world on the prevalence of hypothyroidism in MDR-TB patients on treatment. We searched electronic databases: PubMed/Medline, EMBASE, CINAHL, Science Direct, Academic Search Complete and Google scholar for English language articles without limiting publication year. We also reviewed the bibliographies of relevant studies and conducted an electronic search for relevant conference abstracts. Eligible studies were cross-sectional and cohort studies that included at least five participants. We used a random-effects model to estimate the pooled prevalence of hypothyroidism. The registration number of this review study protocol is CRD42018109237.. We included 30 studies and pooled data on a total of 6,241 MDR-TB patients. The crude prevalence of hypothyroidism was extremely heterogeneous. The pooled prevalence of hypothyroidism in MDR-TB patients on treatment was 17.0% (95% CI: 13.0-20.0). Ethionamide and para-aminosalicylic acid (PAS) were the most frequently reported drugs that associated with the occurrence of hypothyroidism.. This review revealed that hypothyroidism is not a rare adverse drug reaction in MDR-TB patients on treatment. Ethionamide and PAS were the most frequently reported drugs that associated with the occurrence of hypothyroidism. Screening of hypothyroidism in MDR-TB patients on treatment is important while targeting patients on Ethionamide and PAS based treatment regimen.

Topics: Aminosalicylic Acid; Antitubercular Agents; Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Ethionamide; Humans; Hypothyroidism; Risk Factors; Tuberculosis, Multidrug-Resistant

Topics: Adult; Aminoglutethimide; Animals; Antithyroid Agents; Carbimazole; Cobalt; Ethionamide; Female; Fetal Diseases; Goiter; Humans; Hyperthyroidism; Hypothyroidism; Infant, Newborn; Iodides; Lithium; Male; Methimazole; Pregnancy; Pregnancy Complications; Propylthiouracil; Rats; Sulfonamides; Sulfonylurea Compounds; Vegetables

The aim of the study was to elucidate the profile of adverse drug reactions (ADRs) associated with second-line anti-tubercular treatment for drug-resistant tuberculosis.. ADR profile of diagnosed drug-resistant tuberculosis cases on supervised second-line anti-tubercular drug regimen under Programmatic Management of Drug-resistant Tuberculosis under Revised National Tuberculosis Control Programme, were studied over two years' period. Adverse reactions were categorised into mild, moderate and severe types with subsequent systematic data-analysis.. Out of total 207 patients in the study, 81.16% reported with adverse drug reactions. Out of total 195 adverse events, 63.58%, 18.46% and 17.94% were of mild, moderate and severe types respectively. Gastrointestinal events, hepatitis, hearing impairment, arthralgia, psychosis, hypothyroidism, visual disturbances, giddiness, peripheral neuropathy, skin reactions, swelling or pain at injection site, anorexia and sleep disturbances were important amongst these. High proportion of drug and/or alcohol abuse was an important observation. The offending drug(s) had to be terminated in 12.08% of the patients.. Early detection, management and pharmaco-vigilance reporting of ADRs remain key factors in the management of drug-resistant tuberculosis with remarkable relevance of the need for early diagnosis and treatment of 'drug-sensitive tuberculosis', to prevent emergence of drug-resistant tuberculosis.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Arthralgia; Ataxia; Chemical and Drug Induced Liver Injury; Child; Cycloserine; Drug Eruptions; Drug Therapy, Combination; Ethambutol; Ethionamide; Female; Gastrointestinal Diseases; Hearing Loss; Humans; Hypothyroidism; India; Kanamycin; Levofloxacin; Male; Middle Aged; Peripheral Nervous System Diseases; Psychoses, Substance-Induced; Pyrazinamide; Severity of Illness Index; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary; Vision Disorders; Young Adult

Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients.. This was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment.. Between October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54).. High rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.

Topics: Adult; Aminosalicylic Acid; Cohort Studies; Coinfection; Ethionamide; Female; HIV Infections; Humans; Hypothyroidism; Incidence; India; Male; Multivariate Analysis; Prospective Studies; Risk Factors; Stavudine; Thyrotropin; Tuberculosis, Multidrug-Resistant

Topics: Adolescent; Adult; Antitubercular Agents; Ethionamide; Female; Humans; Hypothyroidism; Male; Thyroid Function Tests; Tuberculosis, Multidrug-Resistant; Young Adult

Ethionamide (ETH) treatment may cause hypothyroidism. Clinical data, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were retrospectively assessed in 137 children receiving anti-tuberculosis treatment including ETH. Abnormal thyroid function tests (TFTs) were recorded in 79 (58%) children: elevated serum TSH and suppressed fT4 (n = 30), isolated elevated serum TSH (n = 20), isolated low serum fT4 (n = 28) and isolated low TSH (n = 1). The risk for biochemical hypothyroidism was higher for children on regimens including para-aminosalicylic acid and in human immunodeficiency virus infected children. TFT abnormalities are frequent in children on ETH and are mainly due to primary hypothyroidism or euthyroid sick syndrome.

Topics: Adolescent; Aminosalicylic Acid; Antitubercular Agents; Child; Child, Preschool; Ethionamide; Euthyroid Sick Syndromes; Female; HIV Infections; Humans; Hypothyroidism; Infant; Male; Retrospective Studies; Thyroid Function Tests; Thyrotropin; Thyroxine; Tuberculosis

Topics: Antitubercular Agents; Ethionamide; Female; Humans; Hypothyroidism; Middle Aged; Tuberculosis, Multidrug-Resistant

A 42-year-old woman developed goitrous hypothyroidism while receiving ethionamide for treatment of an atypical mycobacterial infection. Five weeks after discontinuation of ethionamide therapy, thyroid function had returned to normal. The goitrogenic effect was studied in vitro by incubating ethionamide in various concentrations (10(-3) to 10(-7) mol/L) with ovine thyroid cells in tissue cultures. Ethionamide inhibited the trapping of technetium and organification of iodine at concentrations seen clinically (10(-5) mol/L). Ethionamide appears to be a potential goitrogen in susceptible persons.

Topics: Adult; Animals; Ethionamide; Female; Goiter; Humans; Hypothyroidism; In Vitro Techniques; Iodine; Protein Biosynthesis; Sheep; Technetium; Thyroid Gland

Topics: Aminosalicylic Acids; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Cycloserine; Drug Eruptions; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Synergism; Ethambutol; Ethionamide; Female; Gastrointestinal Diseases; Humans; Hypothyroidism; Isoniazid; Kanamycin; Male; Microbial Sensitivity Tests; Pyrazinamide; Recurrence; Rifampin; Streptomycin; Tuberculosis, Pulmonary; Viomycin

Topics: Ethionamide; Female; Goiter; Humans; Hypothyroidism; Iodine; Male; Middle Aged; Thyroid Function Tests; Thyroid Hormones; Thyrotropin; Tuberculosis