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Blood-vessel inflammation and kidney disease can occur in patients with hyperthyroidism treated with propylthiouracil
The background of the study. Patients with hyperthyroidism treated with propylthiouracil (PTU), may have inflammation of blood vessels (vasculitis) associated with serum antibodies that react with white blood cells (neutrophils), known as antineutrophil cytoplasmic antibodies (ANCA). The vasculitis may involve the kidneys.
How the study was done. The study subjects were 19 patients with ANCA-positive vasculitis associated with PTU therapy seen at one hospital in China; 15 of these patients had kidney disease. All had been treated with PTU for hyperthyroidism caused by Graves’ disease for an average of 43 months.
The diagnosis of ANCA-positive vasculitis was based on symptoms and signs of vasculitis (fever, joint pains, skin rash), a positive test for ANCA, and exclusion of other disorders, such as systemic lupus and hepatitis virus infection. Renal disease was defined as the presence of blood or protein in urine. Treatment consisted of cessation of PTU therapy in all patients, and oral or intravenous glucocorticoids or other immunosuppressive drugs.
The results of the study. Four of the 15 patients (27 percent) with PTU-associated ANCA-positive vasculitis and renal disease presented with blood in their urine, 11 had small amounts of blood in their urine, and all 15 patients had high levels of protein in their urine. Kidney biopsies revealed major abnormalities in 12 patients (80 percent).
Thirteen patients (87 percent) were treated with oral prednisone, 7 (47 percent) with intravenous methylprednisolone, and 12 were treated with other immunosuppressive drugs. All patients improved, and 11 (73 percent) had complete disappearance of vasculitis and kidney disease.
The conclusions of the study. Serum ANCA, vasculitis, and kidney disease may occur in patients with hyperthyroidism who are treated with PTU.
The original article. Yu F, Chen M, Gao Y, Wang SX, Zou WZ, Zhao MH, Wang HY. Clinical and pathological features of renal involvement in propylthiouracil-associated ANCA-positive vasculitis. Am J Kidney Dis 2007;49:607-14.
 Next Article: Recurrent hyperthyroidism after antithyroid drug therapy is common in patients with severe Graves’ eye disease |
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
