methimazole and Kidney-Failure--Chronic

Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.

Topics: Anemia; Antithyroid Agents; Autoimmune Diseases; Drug Resistance; Erythropoietin; Humans; Hyperthyroidism; Kidney Failure, Chronic; Male; Methimazole; Middle Aged; Recombinant Proteins; Renal Dialysis

Topics: Acidosis; Adult; Antithyroid Agents; Atrial Fibrillation; Biotransformation; Carbimazole; Diffusion; Drug Administration Schedule; Humans; Hyperthyroidism; Kidney Failure, Chronic; Male; Methimazole; Prodrugs; Renal Dialysis

Thyroid hormone has been reported to affect renal function. To investigate the effects of thyroid hormone on the progression of renal deterioration, thyroid hormone (dried thyroid) and an antithyroid drug (thiamazole) were administered to adriamycin (ADR)-induced renal failure rats. The rats were divided into four groups, including 1) ADR-DT, given dried thyroid and thiamazole; 2) ADR-T, given thiamazole; 3) ADR; and 4) control. The survival rate at the end of the study (22 weeks) was 62.5% in ADR-DT group and 100% in ADR-T, ADR, and control groups, respectively. There was a significant difference in the body weight and pulse rate between ADR-DT and ADR-T or ADR groups, except for the pulse rate at week 6 (P<0.05). The creatinine clearance was greater in the ADR-T group than in the ADR or ADR-DT groups at week 22, and was significantly different between the ADR-T and the ADR-DT groups (P<0.05). The fractional kidney weight and tubular changes were significantly greater in the ADR-DT group than in the ADR-T or ADR groups (P<0.05). The interstitial volume was significantly greater in the ADR-DT group than in the ADR-T group (P<0.05). We therefore conclude that a dried thyroid has an aggravative effect in the tubular changes and relative interstitial volume induced by ADR.

Topics: Animals; Biopsy, Needle; Blood Pressure Determination; Body Weight; Disease Models, Animal; Doxorubicin; Drug Interactions; Female; Heart Rate; Immunohistochemistry; Kidney Failure, Chronic; Kidney Function Tests; Male; Methimazole; Probability; Random Allocation; Rats; Rats, Sprague-Dawley; Reference Values; Risk Factors; Sensitivity and Specificity; Survival Rate; Thyroid Hormones

Topics: Adult; Antithyroid Agents; Graves Disease; Humans; Kidney Failure, Chronic; Male; Methimazole; Pancytopenia; Propylthiouracil

We report here a patient with recurrent Graves' disease on hemodialysis. She also suffered from angina pectoris, which was probably a manifestation of Graves' disease due to the increased oxygen demands in the presence of fixed coronary lesions. Although antithyroid drugs induced mild granulocytopenia, propylthiouracil (PTU) or methimazole (MMI) was not discontinued during the administration of granulocyte colony-stimulating factor (G-CSF). The patient received sodium iodine-131 therapy, and became euthyroid with no chest pain. To our knowledge, this is the first case that illustrated the usefulness of G-CSF for antithyroid drug-induced granulocytopenia prior to thyroid ablation for Graves' disease complicated with chronic renal failure and angina pectoris.

Topics: Agranulocytosis; Angina Pectoris; Antithyroid Agents; Female; Granulocyte Colony-Stimulating Factor; Graves Disease; Humans; Iodine Radioisotopes; Kidney Failure, Chronic; Methimazole; Middle Aged; Propylthiouracil; Renal Dialysis

We describe a 26-year-old male hemodialysis patient with erythropoietin (EPO) resistant anemia associated with primary hyperthyroidism. Use of the anti-hyperthyroid drug, methimazole, led to improvement of his hyperthyroidism and anemia. Before the anti-hyperthyroid therapy, he had received transfusions to maintain an adequate hematocrit during recombinant human EPO therapy. After the therapy, his hyperthyroidism improved and his hematocrit gradually increased without any transfusion. These findings suggest that the patient's EPO resistant anemia was the result of primary hyperthyroidism, and that this complication is reversible if accurate treatment is given.

Topics: Adult; Anemia; Antithyroid Agents; Erythropoietin; Hematocrit; Humans; Hyperthyroidism; Kidney Failure, Chronic; Male; Methimazole; Recombinant Proteins; Renal Dialysis

Differences in the metabolic fate of antithyroid drugs influence the optimal frequency of administration and their therapeutic efficacy. (35)S propylthiouracil differed from the (35)S imidazoles (carbimazole and methimazole) in the more rapid absorption and excretion and the shorter biological half-life in the plasma of the former. Renal function may have a more important influence on the biological half-life of the drugs than thyroid status. Further work is required to determine the optimal frequency of administration for each compound.

Topics: Antithyroid Agents; Carbimazole; Chromatography, Thin Layer; Female; Humans; Hyperthyroidism; Imidazoles; Kidney Failure, Chronic; Methimazole; Propylthiouracil; Sulfur Isotopes