Reactions 1704, p322 - 2 Jun 2018 Thyroid dysfunction and systemic lupus erythematosus: case report A 48-year-old woman developed systemic lupus erythematosus (SLE) following treatment with propylthiouracil. Additionally, she also developed thyroid dysfunction following treatment with prednisone and thiamazole [methimazole; routes not stated; no all dosages and outcomes stated]. The woman, who had Graves’ disease, hypertension and coronary heart disease, was presented with complaints of weakness, dysphoria, chest tightness and wheezes after exercise, irregular menstruation for one year, and weight loss. She was receiving treatment with propylthiouracil, concurrently with metoprolol, valsartan and indapamide. On presentation, a physical examination revealed the body temperature of 36.2°C, pulse rate of 101 beats/min., respiratory rate of 23 breaths/min and BP of 161/89 mm Hg. She was found to have poor spirit, angular face and erythematous patches on her neck. She had symptoms of diffuse goitre, and axillary lymph nodes were palpated. Increased breath sounds noted on both sides of the chest. The symptoms of splenomegaly were noted on an abdominal examination. Oedema of the lower extremities was present. On 25-Mar-2015, she was admitted and underwent various laboratory tests and imaging examinations. Chest and abdomen computed tomography showed signs of focal fibrosis and hydrothorax of double lung, hydropericardium, cholecystitis, hydrocholecystis, pancreatitis, splenomegaly and the mediastinal lymph node enlargement. Doppler sonography of the thyroid revealed multiple thyroid nodules. From all the clinical and laboratory findings, she was diagnosed with SLE, which was considered to be induced by propylthiouracil. The disease activity index of SLE was 14. A percutaneous renal biopsy findings, histological findings and electron microscopy showed lupus nephritis. She further received treatment with prednisone 1 mg/kg/day, concurrently with cyclophosphamide. Her other concurrent medications included metoprolol, indapamide and valsartan. Further, fine- needle aspiration biopsy of the thyroid revealed cellular smear with similar features to hyperplastic nodule. The treatment with propylthiouracil was discontinued following the diagnosis of propylthiouracil-induced SLE. Thereafter, she started receiving treatment with thiamazole 10mg twice a day. After two weeks of the thiamazole treatment, her erythematous patches, fever and oedema resolved; however, the levels of thyrotropin, free thyroxine (T4) and free triiodothyronine (T3) were found to be below the normal limit. Her thyroid dysfunction was considered to be related to prednisone and thiamazole. The woman’s treatment with thiamazole was discontinued. However, prednisone and cyclophosphamide were continued. Examination two months following the thiamazole discontinuation showed below the normal levels of thyrotropin, T3 and T4. Subsequently, the dose of prednisone was reduced by 10% every two weeks. Three months after the dose reduction, her thyrotropin, T3 and T4 levels improved. Four months following the dose reduction, her thyrotropin, T3 and T4 were found to be within the normal limit. Author comment: "Glucocorticoid and methimazole decreased the level of thyroid hormone at the beginning of treatment; however, thyroid-stimulating hormone level does not immediately increase because of glucocorticoid inhibitory effect on hypothalamus." "[Propylthiouracil] was discontinued and methimazole (10 mg bid) was added in case of [propylthiouracil]-induced lupus." Zhanga Y, et al. The onset of systemic lupus erythematosus and thyroid dysfunction following Graves’ disease - A case report and literature review. Srpski Arhiv Za Celokupno Lekarstvo 144: 639-644, No. 11-12, Nov-Dec 2016. Available from: URL: http://doi.org/10.2298/SARH1612639Z - China 803322768 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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