Abstract
BACKGROUND: Drug resistant Tuberculosis is a major public health issue in India. Revised National Tuberculosis Programme (RNTCP) has launched Programmatic Management of Drug Resistant Tuberculosis (PMDT) in the year 2010 in Mumbai India which provides standardized treatment regimen for 24 months associated with various drug side-effects.
AIMS & OBJECTIVES: To monitor the levels of TSH at end of Intensive phase (IP) (6-9) & Continuation phase (CP) (18-24) months.
To study the effect of raised TSH on outcome.
METHODOLOGY: Retrospective & Prospective (Descriptive Longitudinal). Blood was collected at the initiation of treatment; end of IP and at the end of treatment.
TSH was measured using ultrasensitive sandwich chemiluminescent immunoassay.
RESULTS: 4.2% cases had Serum TSH level ≥ 5.5 mcIU/ml at baseline. At IP to CP & End of treatment, proportion of cases with Serum TSH level ≥ 5.5 mcIU/ml showed a statistically significant rise (p=0.001) from baseline (4.2% to 30.3% at end of IP and 42.8% at end of CP). The study reveals that 64.3% cases treated with combination of PAS & Ethionamide had Hypothyroidism which was significantly more as compared to 28.2% cases treated with Ethionamide alone. Amongst 31 HIV-TB patients, baseline TSH was raised in 3 patients; 6 in IP and 5 in CP. Of the 124 patients with raised TSH, 75.8% were cured.
CONCLUSIONS: 4.2% had subclinical hypothyroidism at baseline. There was serial increase in TSH from baseline at end of intensive phase and further at the end of treatment. The increase in TSH was more common with combination of Ethionamide and PAS than with Ethionamide alone. There was no change in the outcome of culture conversion in those with drug induced hypothyroidism.
- Copyright ©the authors 2016