methimazole and Granuloma

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology most commonly affecting young females. The disease was first described in the thyroid gland in 1938. Our patient, a 27-year-old male with known sarcoidosis, was referred to the National University Hospital for acute symptoms of thyrotoxicosis (weight loss of 6 kg, tremor, thyroid enlargement, and tachycardia). Laboratory findings showed suppressed serum thyrotropin (TSH, <0.03 mU/L [0.5-4.20]), increased total thyroxine (T4) (223 nmol/L, [60-140]), and triiodothyronine (T3) (8.5 nmol/L, [1.5-2.7]). Furthermore, Tc-99m pertechnetate scintigraphy disclosed diffuse accumulation of the isotope confirming the diagnosis of Graves' disease. During the next 18 months of antithyroid treatment (thiamazole, Thycapzol) hyperthyroidism was difficult to control, the thyroid gland gradually enlarged, and surgery was recommended. Initially, the patient declined surgery but after an additional 18 months, he accepted surgery. During the 36-month period of antithyroid drug treatment TSH was suppressed (<0.01 mU/L) and T3 often elevated despite high doses of thiamazole. Total thyroidectomy was performed, and histologic examination of the removed thyroid tissue confirmed the diagnosis of Graves' disease and also the presence of sarcoid granuloma and metastatic papillary adenocarcinoma with spread to neck lymph nodes. Four months later, a modified radical neck dissection was performed with removal of neck lymph nodes followed by external radiation therapy (2 Gy x 32 fractions to the neck). The concomitant presence of sarcoidosis, papillary carcinoma, and Graves' disease in a thyroid gland, to our knowledge, has not previously been described in the literature.

Topics: Adult; Antithyroid Agents; Carcinoma, Papillary; Granuloma; Graves Disease; Humans; Lymphatic Metastasis; Male; Methimazole; Sarcoidosis; Thyroid Diseases; Thyroid Neoplasms; Thyrotropin; Thyroxine; Triiodothyronine

A very rare case of granulomatous hepatitis in a 56-year old woman with hyperthyroidism, under long-term treatment with methimazole, is reported. Liver biopsy showed multiple non caseous granulomas in the portal triads, consisted of epithelioid and multinucleated cells, lymphocytes and isolated eosinophils. The presence of eosinophils in granulomas, could indicate an iatrogenic aethiology.

Topics: Chemical and Drug Induced Liver Injury; Female; Granuloma; Humans; Hyperthyroidism; Methimazole; Middle Aged

We tested the ability of human peripheral blood monocytes to kill Candida albicans and Candida parapsilosis. Evidence that multiple fungicidal mechanisms operate in normla monocytes was found. Normal monocytes ingested and killed viable C. albicans, and could iodinate heat-killed C. albicans. Both functions were defective in monocytes from subjects with myeloperoxidase deficiency or chronic granulomatous disease. Methimazole, isoniazid, and aminotriazole inhibited iodination by normal monocytes without impairing their ability to kill C. albicans, indicating that iodination was not essential to the myeloperoxidase-hydrogen peroxide-mediated fungicidal system of the monocyte. C. parapsilosis, an organism killed with supranormal efficacy by monocytes from a patient with hereditary myeloperoxidase deficiency, was selected to examine the myeloperoxidase-independent fungicidal mechanisms of monocytes. Monocytes were obtained from the blood of normal or leukemic subjects and homogenized in 0.34 M sucrose to yield fractions rich in cytoplasmic granules. These fractions were extracted with 0.01 M citric acid and the soluble components were separated by micropreparative polyacrylamide electrophoresis. Monocytes were found to contain cationic proteins, other than myeloperoxidase, that kill C. parapsilosis in vitro.

Topics: Anti-Inflammatory Agents; Candida; Candida albicans; Female; Granuloma; Humans; Iodides; Isoniazid; Leukemia, Monocytic, Acute; Lymphocyte Culture Test, Mixed; Male; Methimazole; Monocytes; Neutrophils; Peroxidases; Phagocytosis; Subcellular Fractions

Topics: Adult; Autoradiography; Bacteria; Blood Bactericidal Activity; Child, Preschool; Female; Granuloma; Hexosephosphates; Humans; Hydrogen Peroxide; Infant; Infections; Iodine; Iodine Isotopes; Lactobacillus acidophilus; Leukocytes; Lymphadenitis; Male; Methimazole; Neutrophils; Oxygen Consumption; Peroxidases; Phagocytosis; Serratia marcescens