Hamada Yuto, Sato Akiyuki, Motojima Shinji
Kekkaku. 2017 Jan;92(1):41-45.
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.
利福平可诱发甲状腺功能减退。我们报告一例肺结核合并结核性胸膜炎并发利福平诱发的甲状腺功能减退病例。该患者接受了以利福平为基础的抗结核治疗，并出现持续食欲减退，这促使我们同时给予甲状腺功能减退治疗。一名85岁无潜在甲状腺相关疾病的女性因食欲和体重下降3个月就诊于当地医院。胸部X线片显示双侧肺下野有胸腔积液和浸润性阴影，我们还在胸腔积液中检测到高水平的淋巴细胞和腺苷脱氨酶水平（49.6 IU/1），痰样本聚合酶链反应检测结果呈阳性。因此，我们诊断该患者为肺结核合并结核性胸膜炎，并开始使用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行治疗。她的临床病程良好，厌食症状有所改善。然而，她随后又出现反复食欲减退、不适和双侧小腿水肿。随访实验室检查显示她出现了甲状腺功能减退。我们在不中断抗结核治疗的情况下开始使用左甲状腺素进行治疗。食欲减退和其他甲状腺相关症状得到改善。患者入院时甲状腺功能正常，未发现桥本甲状腺炎或其他甲状腺疾病。根据临床病程，我们得出结论，是利福平诱发了甲状腺功能减退。因此，即使患者似乎将厌食作为药物不良反应，对于持续食欲减退的病例也应考虑利福平诱发的甲状腺功能减退。
