Two cases of multi-drug-resistant pulmonary tuberculosis with para-aminosalicylicacid (PAS)-induced hypothyroidism were reported.
Case 1; a 73-year-old male, complaining of edema, was admitted to our hospital. Hehad been treated for his multirug-resistant pulmonary tuberculosis during the past 1year with an antituberculous regimen consisting of ethambutol (EB), ethionamide (ETH) and PAS. A thyroid profile performed when he was admitted to our hospital showed severalmarked abnormalities: serum thyroid stimulating hormone (TSH) was elevated (69.4 ii IU/ml: normal, 0.4-4.2 m IU/
ml), free thyroxine level (T4) (0.01 ng/
dl; normal, 0.70-1.60 ng/
dl) and free triiodothyronine level (T3) (0.60 pg/
ml; normal, 2.3-4.1 pg/
ml) were low.
PAS was discontinued after he was admitted to our hospital, since PAS was believed to bethe cause of the hypothyroidism. A thyroid profile that was repeated after the exclusionof PAS from treatment showed the following results: the TSH level was decreased (13.4m IU/
ml), the free T4 (0.93 ng/
dl) were normal. During treatment with PAS, he hadnever received thyroid replacement therapy.
Case 2; A 22-year-old female, complaining of hemosputum. She had been treated forher multi-rug-resistant pulmonary tuberculosis during the past 11 months with anantituberculous regimen consisting of EB, ETH and PAS. A thyroid profile performed when she was admitted to our hospital showed several marked abnormalities: elevatedserum TSH (112.7 m IU/
ml), and low T4 (2.0 μg/ dl) and T 3 (1.1 ng/
ml). A thyroid profilethat was repeated after the exclusion of PAS from treatment showed the followingresults: the TSH level was decreased (5.1m IU/
ml). Drug-induced hypothyroidism is aninfrequent side effect of therapy with PAS, and only a few cases of PAS-induced hypothyroidismhave been reported so far. In this report, we describe patients with hypothyroidismwho were receiving therapy for multi-drug-resistant tuberculosis, tuberculosisnamely, resistant to at least isoniazid (INH) and rifampicin (RFP), with a regimen thatcontained PAS.
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