Autoimmune thyroiditis and isotretinoin: real association or coincidence?

Guerouaz, N.; Jean, M. Saint; Peuvrel, L.; Dréno, Brigitte

doi:10.1111/jdv.12577

Cited by 5 publications

(3 citation statements)

References 6 publications

(7 reference statements)

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“…On a separate note, in 2014, Guerouaz et al reported a case on 2-year-old twin brothers who were treated with isotretinoin for inflammatory acne conglobate. The twins developed autoimmune thyroiditis [7]. In both these cases, either patients had a negative family history of autoimmune thyroid disease or no family history was recorded.…”

Section: Discussionmentioning

confidence: 99%

Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Nugroho

Schweiger

2017

Case Reports in Pediatrics

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Introduction. Isotretinoin is commonly used to treat cystic acne. Definitive mechanisms of action for isotretinoin are not known though despite many side effects having been documented. Various case reports have noted autoimmune diseases succeeding isotretinoin treatment. Case Report. A 16-year-old female presents with symptoms of tremors, lack of focus, sleeplessness, emotional liability, bulging eyes, loose stools, heat intolerance, and missed menstrual periods. Symptoms manifested shortly after the patient finished a course of oral isotretinoin treatment for acne. Physical exam showed resting tremors, bilateral proptosis, hyperactivity, and rapid speech. A diagnosis of Graves' Disease was made by correlating symptoms, physical exam findings, ultrasound, and positive family history of autoimmune thyroid disease. Conclusion. Emergence of autoimmune thyroid diseases depends upon genetic predisposition and environmental triggers. Mechanism of action for isotretinoin is not known but the drug may play a role in triggering autoimmunity in genetically susceptible individuals.

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Section: Discussionmentioning

confidence: 99%

Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Nugroho

Schweiger

2017

Case Reports in Pediatrics

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“…Isotretinoin has an immunomodulatory effect through its role in apoptosis and activation of B and T lymphocytes 19 . This effect was suspected to trigger some autoimmune diseases such as diabetes 20 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of thyroid dysfunctions in adolescent patients suffering from severe acne during isotretinoin treatment

Hareedy

Mahmoud

Tawfik

2021

Clin Exp Pharma Physio

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Although oral isotretinoin has been widely used as a basic treatment of acne in adolescents, several studies have noted some alterations in thyroid functions during oral isotretinoin therapy. Therefore, the present study aims at evaluating the possible changes in thyroid‐stimulating hormone (TSH), free thyroxin (fT4) and free triiodothyronine (fT3) levels during isotretinoin treatment and analyzing the possible factors which may contribute to such changes. In the present study, 47 patients received (0.5 mg/kg oral isotretinoin) for treatment of severe acne. TSH, fT4 and fT3 were measured at baseline, after 3 and 6 months. ANOVA tests were used for statistical analyses. The levels of fT4 and fT3 decreased significantly during isotretinoin treatment (from 0.85 ± 0.04 and 3.1 ± 0.26 at baseline to 0.81 ± 0.023 and 2.76 ± 0.2 after 6 months, respectively). The decrease was accompanied by significant elevation of TSH (0.66 ± 0.05 at baseline to 0.695 ± 0.05 after 6 months). The duration of therapy (but not the dose) has significantly affected all the hormonal changes. Previous incomplete or intermittent isotretinoin treatment had significantly influenced the changes in fT4 only, while gender affected the changes of TSH. Isotretinoin treatment can decrease fT4, fT3 and increase TSH. The pattern of these changes was affected by gender and previous isotretinoin therapy. Different doses of isotretinoin did not affect the hormonal changes, but the duration has been the major influencing factor.

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“…It is well known to cause central hypothyroidism, but isotretinoin has not shown this affinity. Thyroid abnormalities secondary to isotretinoin have been reported since the 1980s, 60–65 but the number of cases is small, and no pattern of timeline or abnormalities has emerged to support causation. Since the 1980s prospective cohort studies have followed patients receiving isotretinoin to investigate the influence of isotretinoin on hormonal homeostasis 48,65–69 .…”

Section: Methodsmentioning

confidence: 99%

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Affleck

Jackson

Williams

et al. 2022

British Journal of Dermatology

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Summary Clinical question Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? Background Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. Data sources We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. Study selection Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. Data extraction Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. Results We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre‐existing conditions. Recommendation for clinical care We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.

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Autoimmune thyroiditis and isotretinoin: real association or coincidence?

Cited by 5 publications

References 6 publications

Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Patterns of thyroid dysfunctions in adolescent patients suffering from severe acne during isotretinoin treatment

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

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