propylthiouracil and Arthritis

Topics: Adult; Antithyroid Agents; Arthritis; Female; Graves Disease; Humans; Methimazole; Propylthiouracil; Syndrome

Antineutrophil cytoplasmic antibody (ANCA)- associated vasculitis is a potentially life-threatening adverse effect of antithyroid medications. We present a 22-year-old woman with Graves' disease who developed recurrent episodes of arthritis while on treatment with propylthiouracil. A diagnosis of propylthiouracil-induced ANCA-associated vasculitis was established only after exhaustive rheumatological investigations failed to establish a cause for her arthritis. Anti-myeloperoxidase antibody (anti-MPO) titres were grossly elevated at 172.7 RU/mL (0-20). Her arthritis resolved promptly following the withdrawal of propylthiouracil and the anti-MPO titres declined over 16 months to 66.8 RU/mL. While she did not develop the life-threatening renal or respiratory tract complications, there was a delay in establishing the correct diagnosis with its attendant morbidity. This case highlights the need for greater awareness of this relatively rare adverse effect of antithyroid medications so as to allow its early detection, leading to the prompt cessation of the offending medication.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Arthritis; Female; Graves Disease; Humans; Propylthiouracil; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antithyroid Agents; Arthritis; Diagnosis, Differential; Food Hypersensitivity; Foot Diseases; Hematologic Tests; Humans; Hyperthyroidism; Male; Propylthiouracil; Vasculitis

Antithyroid drugs adverse effects are varied and rare. Autoimmune disorders (vasculitis, lupus erythematosus, polyarthritis...) are unusual and serious complications of antithyroid drugs. Since 1945, fewer than 100 cases of systemic manifestations related to antithyroid drugs have been reported in the literature, most frequently with propylthiouracil. The outcome is usually good after drug discontinuation, but some fatal cases have been reported. Because possible cross-sensitivity with other antithyroid drugs, the appropriate treatment for hyperthyroidism relapse if a patient has had an antithyroid drug adverse reaction, should be 131I-Iodine or surgery. We report four new cases of systemic manifestations during propylthiouracil therapy.

Topics: Adult; Antithyroid Agents; Arthritis; Diagnosis, Differential; Female; Follow-Up Studies; Graves Disease; Humans; Lupus Erythematosus, Systemic; Middle Aged; Propylthiouracil; Recurrence; Thyroidectomy; Vasculitis

Topics: Antithyroid Agents; Arthritis; Female; Goiter, Nodular; Humans; Methimazole; Middle Aged; Propylthiouracil

Severe adverse reactions to propylthiouracil occur in 1-5% of patients. Three major side effects, namely agranulocytosis, hepatotoxicity and drug-induced hypersensitivity, have been described though these syndromes are not distinct entities and there can be overlaps in the clinical manifestations. The drug-induced hypersensitivity may be an immune-mediated reaction with multiorgan involvement in which a combination of polyarthritis, cutaneous vasculitis and fever is common. We report a patient with propylthiouracil-induced hypersensitivity with an unusual combination of high spiking fever, migratory polyarthritis, reversible sensorineural deafness, normochromic normocytic anaemia, leucocytosis and hepatotoxicity associated with polyclonal activation of multiple autoantibodies. This case illustrates the highly variable clinical manifestations of the syndrome. The prompt recovery upon withdrawal of the drug indicates the importance of early diagnosis.

Topics: Adult; Arthritis; Carbimazole; Drug Hypersensitivity; Female; Graves Disease; Hearing Loss, Sensorineural; Humans; Propranolol; Propylthiouracil; Thyroxine

Topics: Adult; Arthritis; Humans; Male; Methimazole; Propylthiouracil

Topics: Adult; Arthritis; Female; Humans; Hyperthyroidism; Leukopenia; Propylthiouracil; Skin; Vasculitis, Leukocytoclastic, Cutaneous

The results of medical and surgical therapy were determined in 107 hyperthyroid children. After surgery, 85% of patients were rendered free of hyperthyroidism; however, 62% became hypothyroid. After medical treatment, 30% of patients were euthyroid and 2% became hypothyroid. The relapse rate, however, was higher after medical (22%) than after surgical (9%) therapy. Serious drug-related complications (arthritis-, hepatitis-, and collagen disease-like syndromes) occurred in 14% of patients. Complications occurred in 9% of surgically treated patients, but recurrent laryngeal nerve injury or permanent hypoparathyroidism did not occur. In medically treated patients, both a goiter size less than three times normal prior to treatment and a reduction in goiter size to less than two times normal at the completion of therapy correlated with a successful outcome.

Topics: Adolescent; Arthritis; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Collagen Diseases; Female; Humans; Hyperthyroidism; Hypothyroidism; Male; Methimazole; Postoperative Complications; Propylthiouracil; Thyroidectomy

Topics: Adult; Antithyroid Agents; Arthritis; Female; Humans; Iatrogenic Disease; Imidazoles; Methimazole; Middle Aged; Propylthiouracil