Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field

We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment;the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on antiretroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.

Adverse Drug Reactions in Management of Multi Drug Resistant Tuberculosis, in Tertiary Chest Institute

Background: Multidrug resistant tuberculosis is a global threat. Effective treatment is implemented as per RNTCP guidelines. But the drugs used have great potential to develop adverse drug reactions. Such drug reactions if not managed optimally can lead to unfavourable treatment outcome. Hence, the study is to know the occurrence of adverse drug reactions. Aims: To study the occurrence of adverse drug reactions in treatment of multidrug resistant tuberculosis and hence the factors affecting the treatment. Settings and Design: Retrospective analysis of patients treated with standardised regimen for MDR-TB, as per RNTCP guidelines at a tertiary chest institute between august 2011 and December 2014. Methods and Material: Retrospective analysis of 607 patients’ records reviewed for the occurrence of adverse drug reactions. All adverse reactions are noted and diagnosed either clinically or by laboratory evidence. Results: Among the 607 patients included in the study, majority had one or more adverse drug reactions. The most common was gastritis (71.7%), which was easily treatable, and the least common was visual impairment (0.2%). Only 1.7% discontinued the treatment citing adverse drug reactions and 10.5% required permanent discontinuation of the offending drug. Conclusion: Treatment of MDR-TB is challenging mainly due to the long duration of treatment and the potential adverse reactions of the drugs used. These reactions are frequent but majority of them can be successfully managed without treatment interruption. Training the peripheral health centre workers to identify and refer the patients with adverse reaction bears a major impact on treatment outcome.