minocycline and Thyroid-Diseases

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Female; Humans; Minocycline; Rosacea; Syndrome; Thyroid Diseases; Thyroid Gland

We report a case of an unpigmented papillary carcinoma arising in a black thyroid induced by minocycline. Black thyroid syndrome is an unusual pigmented change seen almost exclusively in patients on minocycline, apparently resulting from an oxidative interaction between thyroid peroxidase and the drug. Twenty-six cases have previously been reported in the English literature, nine of which described an associated thyroid neoplasm. Four of these nine neoplasms were described as pale or hypopigmented. The nature of the lesion against the background of pigmentation suggests diminished function of the thyroid peroxidase in this clonal population.

Topics: Adult; Anti-Bacterial Agents; Biopsy, Needle; Carcinoma, Papillary; Female; Humans; Hypopigmentation; Minocycline; Pigmentation Disorders; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy

Topics: Acne Vulgaris; Adult; Humans; Male; Minocycline; Pigmentation Disorders; Suicide; Thyroid Diseases; Thyroid Gland; Time Factors; Wounds, Gunshot

We report a rare case of black thyroid accompanied by papillary carcinoma in a patient with an extended history of minocycline treatment. A 78-year-old man was referred to our outpatient clinic with swelling in his neck. He had been taking minocycline for the previous 2 years and 7 months to treat chronic perianal pyoderma. Neck ultrasonography and computed tomography demonstrated a 3.5 × 3.7 × 5.0-cm nodule in the left thyroid lobe, and fine-needle aspiration cytology identified it as a papillary carcinoma. The patient underwent a total thyroidectomy and neck dissection. During the procedure, a distinct black discoloration of the thyroid parenchyma was observed. Histopathology confirmed both the black thyroid and the papillary carcinoma. Based on the thyroid gland's discoloration and the history of minocycline use, the patient was diagnosed with minocycline-induced black thyroid. He was symptom-free 20 months after surgery.

Topics: Aged; Anti-Bacterial Agents; Anus Diseases; Carcinoma; Carcinoma, Papillary; Humans; Male; Minocycline; Neck Dissection; Pigmentation Disorders; Pyoderma; Thyroid Cancer, Papillary; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome

Topics: Aged; Female; Humans; Minocycline; Thyroid Diseases; Thyroid Gland

Topics: Administration, Oral; Aged; Fatal Outcome; Female; Humans; Minocycline; Pigmentation; Thyroid Diseases

Vitamin D research is discussed in light of the hypothesis that the lower average levels of vitamin D frequently observed in autoimmune disease are not a sign of deficiency. Instead, it is proposed that the lower levels result from chronic infection with intracellular bacteria that dysregulate vitamin D metabolism by causing vitamin D receptor (VDR) dysfunction within phagocytes. The VDR dysfunction causes a decline in innate immune function that causes susceptibility to additional infections that contribute to disease progression. Evidence has been accumulating that indicates that a number of autoimmune diseases can be reversed by gradually restoring VDR function with the VDR agonist olmesartan and subinhibitory dosages of certain bacteriostatic antibiotics. Diseases showing favorable responses to treatment so far include systemic lupus erythematosis, rheumatoid arthritis, scleroderma, sarcoidosis, Sjogren's syndrome, autoimmune thyroid disease, psoriasis, ankylosing spondylitis, Reiter's syndrome, type I and II diabetes mellitus, and uveitis. Disease reversal using this approach requires limitation of vitamin D in order to avoid contributing to dysfunction of nuclear receptors and subsequent negative consequences for immune and endocrine function. Immunopathological reactions accompanying bacterial cell death require a gradual elimination of pathogens over several years. Practical and theoretical implications are discussed, along with the compatibility of this model with current research.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Reactive; Arthritis, Rheumatoid; Autoimmune Diseases; Bacterial Infections; Calcifediol; Calcitriol; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; Imidazoles; Minocycline; Psoriasis; Receptors, Calcitriol; Sarcoidosis; Scleroderma, Systemic; Sjogren's Syndrome; Spondylitis, Ankylosing; Tetrazoles; Thyroid Diseases; Uveitis

Topics: Anti-Bacterial Agents; Biopsy, Fine-Needle; Carcinoma, Papillary; Humans; Minocycline; Pigmentation; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

We report on a 37-yr-old woman with known antemortem ingestion of minocyclin who died suddenly from a ruptured cerebral aneurysm. At autopsy, her thyroid gland, although not enlarged, was diffusely black, caused by the deposition of a melanin-like pigment that stained positive with Schmorl's reagent. The pigment could be bleached with permanganate, and on examination by electron microscopy, it appeared to be deposited within the thyrocyte lysosomes. Additional immunostaining with many antibodies revealed an increase in vimentin staining in the follicular epithelium compared with normal control thyroid glands. Staining for cytoplasmic thyroglobulin was markedly reduced, despite normal thyroid indices performed on stored antemortem blood. Stainable ubiquitin in the follicular epithelium appeared reduced compared with control thyroid tissues. These immunohistochemical findings may reflect disruptions of lysosomal transport and function associated with the abnormal accumulation of pigment. This appears to be the only case of minocyclin-associated "black thyroid" in which extensive immunohistochemical investigations have been performed.

Topics: Adult; Biomarkers; Female; Humans; Immunohistochemistry; Lysosomes; Minocycline; Pigmentation Disorders; Pigments, Biological; Thyroglobulin; Thyroid Diseases; Thyroid Gland; Vimentin

Black pigmentation of the thyroid attributed to minocycline hydrochloride is known, but to our knowledge, pigmentation associated with antidepressants has not been reported. We studied four patients with papillary carcinoma associated with thyroid pigmentation; two had received minocycline therapy, and two had received long-term treatment with antidepressants. The thyroids of patients who had been treated with minocycline were black, with pigment primarily in nontumorous tissue. The thyroids associated with antidepressant therapy were dark red, with pigment in both tumorous and nontumorous tissue. All four cases were positive for periodic acid-Schiff, periodic acid-Schiff with diastase predigestion, and Schmorl's stains and negative for Prussian blue; the results differed from those found with Fontana's technique. Minocycline-related pigmentation appears to imply a role for the iodide peroxidase system in the accumulation of pigment, whereas pigmentation attributed to intake of antidepressants appears to result from lysosomal accumulation of the drug itself.

Topics: Adult; Antidepressive Agents; Carcinoma, Papillary; Female; Humans; Microscopy, Electron; Middle Aged; Minocycline; Pigmentation Disorders; Thyroid Diseases; Thyroid Neoplasms

Topics: Adult; Female; Foreign-Body Reaction; Humans; Minocycline; Pigmentation; Thyroid Diseases; Thyroid Gland

A case of papillary thyroid carcinoma occurring in a 27-year-old man with black thyroid syndrome is reported. The tumor, in contrast to the remaining thyroid, was not pigmented. The significance and potential utility of the differential pigmentation are discussed.

Topics: Adult; Carcinoma, Papillary; Humans; Male; Minocycline; Pigmentation Disorders; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

We analyzed the effects of tetracycline hydrochloride or minocycline hydrochloride sclerotherapy on 66 recurrent thyroid cysts. All were hemorrhagic lesions except one serous cyst; cytologic study showed all were benign. On average, three treatments were given until resolution or the patient became unavailable for follow-up. The cumulative frequency of cyst disappearance was 33%, 45%, 52%, and 59% after 1, 2, 3, and 4 treatments. Five additional patients had cyst resolution after six to 19 treatments, and the serous lesion did not resolve. Cysts requiring more than two treatments were larger at presentation than those resolving after one or two treatments. Side effects in 179 treatments were local pain lasting ten to 20 minutes in 4.5%, radiated pain lasting one to two hours in 4.5%, fatigue lasting one to two days in 3.9%, and a febrile sensation lasting one to two days in 2.8%. Hemorrhagic thyroid cysts can usually be cured by repeated tetracycline or minocycline sclerotherapy with tolerable side effects.

Topics: Cysts; Female; Hemorrhage; Humans; Male; Middle Aged; Minocycline; Recurrence; Sclerosing Solutions; Suction; Tetracycline; Tetracyclines; Thyroid Diseases

Thyroid pigments in black thyroid glands from minocycline-treated patients were compared by light and electron microscopy, histochemistry, and energy-dispersive x-ray analysis with minocycline-induced pigment in thyroid glands of laboratory animals, and with naturally occurring lipofuscins in untreated laboratory animals and humans. All thyroid samples examined contained nonbirefringent, Schmorl-positive pigment. However, the pigments in black thyroids from minocycline-treated patients resembled lipofuscins of untreated humans since both fluoresced and were Ziehl-Neelsen- and Sudan IV-positive. Minocycline induced pigment in rats was nonfluorescent and Ziehl-Neelsen- and Sudan IV-negative. Ultrastructurally, pigments in black thyroid glands of minocycline-treated humans resembled lipofuscins in untreated humans, and initial elemental analyses yielded similar spectra. Repeated analyses of the most electron-dense pigment deposits yielded spectra that resembled those of minocycline-induced pigment in laboratory animals-ie, both contained calcium. Black thyroid glands associated with minocycline administration contained predominantly lipofuscins with a small amount of another, possibly minocycline-related pigment. The absence of functional changes in patients and animals given minocycline suggests that discoloration of the thyroid gland associated with minocycline administration is innocuous. This is further supported by the lack of documented changes in thyroid physiology in patients that have received tetracyclines for a variety of indications in the last 30-odd years since their introduction to therapy.

Topics: Adult; Aged; Animals; Dogs; Electron Probe Microanalysis; Guinea Pigs; Haplorhini; Humans; Lipofuscin; Microscopy, Electron; Middle Aged; Minocycline; Pigmentation Disorders; Pigments, Biological; Rats; Tetracyclines; Thyroid Diseases; Thyroid Gland

A 20 yr-old male, with a long history of severe acne vulgaris treated with minocycline hydrochloride, died as a result of a motor bike accident. An incidental finding at postmortem was black pigmentation of the thyroid, which was evident histologically as brown-black granules within the cytoplasm of thyroid follicular cells. Ultrastructural examination showed cytoplasmic bodies, of the same type as seen in normal thyroids. Previous cases were reviewed, and the possibility that the pigment is related to lipofuscin discussed.

Topics: Adult; Humans; Male; Minocycline; Pigmentation Disorders; Tetracyclines; Thyroid Diseases; Thyroid Gland

We studied a patient with a grossly black thyroid gland considered to be related to minocycline therapy. Microscopically, a brown granular pigment was localized in follicular cells and colloid, which histochemically was melanin or a melaninlike substance. Ultrastructurally, the pigment is confined to lysosomes. The pigment seems to be either an oxidative degradation product of the drug itself, or the results of an as yet unknown alteration of tyrosine metabolism by the drug. Although minocycline is known to interfere with thyroid function in animals, no evidence has been presented for such an effect in humans. The occurrence of a black thyroid gland in humans seems to be virtually pathognomonic for long-term minocycline therapy.

Topics: Humans; Lysosomes; Male; Melanins; Middle Aged; Minocycline; Pigmentation Disorders; Rosacea; Tetracyclines; Thyroid Diseases; Thyroid Gland; Tyrosine

Topics: Acne Vulgaris; Adult; Color; Female; Humans; Hyperplasia; Minocycline; Pigmentation Disorders; Tetracyclines; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland