rifampin and Hypothyroidism

Topics: Antitubercular Agents; Autoantibodies; Hashimoto Disease; Humans; Hypothyroidism; Immunoglobulins, Thyroid-Stimulating; Prognosis; Receptors, Thyrotropin; Rifampin; Thyroid Hormones

Topics: Cushing Syndrome; Female; Humans; Hypothyroidism; Iodine; Pregnancy; Pregnancy Complications; Receptors, Thyrotropin; Rifampin; Thyroid Hormones; Thyroiditis, Autoimmune

Levothyroxine (L-T4) absorption varies between individuals, and can be affected by various concomitantly administered drugs. Case reports have indicated an association between cotreatment with ciprofloxacin or rifampin and hypothyroidism in patients on a stable L-T4 dose.. The effects of two antibiotics on T4 absorption were prospectively assessed in a double-blind, randomized, crossover fashion. Eight healthy volunteers received 1000 μg L-T4 combined with placebo, ciprofloxacin 750 mg, or rifampin 600 mg as single doses. We measured total plasma thyroxine (T4) concentrations over a 6-hour period after dosing using liquid chromatography-tandem mass spectrometry. For each study arm, areas under the T4 plasma concentration-time curve (T4 AUCs) were compared.. Coadministration of ciprofloxacin significantly decreased the T4 AUC by 39% (p = 0.035), while, surprisingly, rifampin significantly increased T4 AUC by 25% (p = 0.003).. Intestinal absorption of L-T4 is differentially affected by acute coadministration of ciprofloxacin or rifampin. Mechanistic studies focused on intestinal and possibly hepatic thyroid hormone transporters are required to explain the observed drug interactions with L-T4.

Topics: Absorption; Administration, Oral; Adolescent; Adult; Area Under Curve; Ciprofloxacin; Cross-Over Studies; Double-Blind Method; Drug Interactions; Female; Humans; Hypothyroidism; Intestinal Absorption; Liver; Male; Prospective Studies; Rifampin; Thyroid Hormones; Thyroxine; Time Factors; Young Adult

Rifampicin can induce hypothyroidism. We report a case of pulmonary tuberculosis and tuberculous pleurisy that was complicated by rifampicin-induced hypothyroidism. The patient received rifampicin-based tuberculosis treatment and experienced persistent appetite loss, which led us to pro- vide concomitant hypothyroidism treatment. An 85-year-old woman with no underlying thyroid-related disease presented to her local hospital with a 3-month history of appetite and weight loss. A chest radiograph revealed pleural effusions and infiltrative shadows in the lower fields of both lungs, and we also detected high levels of lympho- cytes and adenosine deaminase levels (49.6 IU/1) in the pleu- ral effusion, with positive results from a polymerase chain reaction assay of a sputum sample. Thus, we diagnosed the patient with pulmonary tuberculosis and tuberculous pleurisy, and initiated treatment using isoniazid, rifampicin, etham- butol, and pyrazinamide. Her clinical course was good and her anorexia was improved. However, she subsequently experienced recurrent appetite loss, malaise, and bilateral lower-leg edema. Follow-up laboratory testing revealed that she had developed hypothyroidism. We started treatment using levothyroxine without interrupting the tuberculosis treatment. The loss of appetite and other thyroid-related symptoms were improved. The patient's thyroid function had been normal at her admission, and there were no findings of Hashimoto's thyroiditis or other thyroid conditions. Based on the clinical course, we conclude that the rifampicin induced the hypothyroidism. Therefore, rifampicin-induced hypothyroidism should be considered in cases with persistent appetite loss, even if the patient appears to be experiencing anorexia as an adverse drug reaction.

Topics: Aged, 80 and over; Antibiotics, Antitubercular; Female; Humans; Hypothyroidism; Rifampin; Treatment Outcome; Tuberculosis, Pleural; Tuberculosis, Pulmonary

Levothyroxine (LT4) and rifampin (RIF) are sometimes used together; however, no clinical studies have assessed the effects of these drugs on thyroid function or the need to adjust LT4 dose.. We retrospectively reviewed the records of 71 Korean patients who started RIF during LT4 treatment. Clinically relevant cases that required dose adjustment according to the American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) guidelines were identified, and risk factors of increased LT4 dose were analyzed.. After administering RIF, median serum thyroid-stimulating hormone (TSH) level (2.58 mIU/L, interquartile range [IQR] 0.21-7.44) was significantly higher than that before RIF (0.25 mIU/L, IQR, 0.03-2.62; P < 0.001). An increased LT4 dose was required for 50% of patients in the TSH suppression group for thyroid cancer and 26% of patients in the replacement group for hypothyroidism. Risk factor analysis showed that remaining thyroid gland (odds ratio [OR] 9.207, P = 0.002), the time interval between starting RIF and TSH measurement (OR 1.043, P = 0.019), and baseline LT4 dose per kg body weight (OR 0.364, P = 0.011) were clinically relevant variables.. In patients receiving LT4, serum thyroid function test should be performed after starting RIF treatment. For patients with no remnant thyroid gland and those receiving a lower LT4 dose, close observation is needed when starting RIF and TB medication.

Topics: Adult; Female; Humans; Hypothyroidism; Logistic Models; Male; Middle Aged; Odds Ratio; Retrospective Studies; Rifampin; Risk Factors; Thyroid Function Tests; Thyroid Gland; Thyrotropin; Thyroxine

Topics: Antitubercular Agents; Biopsy; Combined Modality Therapy; Deglutition Disorders; Drainage; Ethambutol; Goiter; Hormone Replacement Therapy; Humans; Hypothyroidism; Isoniazid; Lymphatic Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pyrazinamide; Rifampin; Thyroiditis; Thyroxine; Tuberculosis, Endocrine

Rifampin (RFP) increases hepatic microsomal enzyme activity, and there are case reports of RFP-induced hypothyroidism, all associated with Hashimoto's thyroiditis. Here, we report a case of RFP-induced hypothyroidism without underlying thyroid disease.

Topics: Adult; Antibiotics, Antitubercular; Female; Humans; Hypothyroidism; Rifampin; Thyroid Function Tests; Thyroid Gland; Tuberculosis, Pulmonary

Topics: Aged; Antibiotics, Antitubercular; Female; Humans; Hypothyroidism; Male; Middle Aged; Rifampin; Thyroid Hormones; Thyroiditis, Autoimmune; Tuberculosis

Rifampin is a potent inducer of hepatic enzymes and is well documented to cause many clinically significant drug interactions. Studies in normal volunteers have shown its ability to decrease circulating levels of thyroid hormone, while having no effect on thyroid-stimulating hormone (TSH). Reports of rifampin's effects on patients on hormone replacement in the clinical setting are of interest since we believe only one such case has been described. We report the case of a man, stable on levothyroxine, who exhibited significantly elevated TSH levels during therapy with rifampin. Thyroid-stimulating hormone levels returned to baseline 9 days after discontinuance of rifampin.

Topics: Drug Interactions; Enzyme Induction; Humans; Hypothyroidism; Liver; Male; Middle Aged; Rifampin; Surgical Wound Infection; Thyrotropin; Thyroxine

Topics: Adult; Female; Humans; Hypothyroidism; Rifampin; Thyroid Function Tests; Thyroidectomy; Thyrotropin; Thyroxine

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