Black thyroid resulting from short-term doxycycline use: Case report, review of the literature, and discussion of implications

Miller, Kyle E.; Lewis, C; Bentz, Brandon G.

doi:10.1002/hed.20385

Cited by 22 publications

(19 citation statements)

References 13 publications

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“…All hospitalized subjects had antibiotic use within six months of serum sample collection, while 47.2% of ambulatory subjects had recent antibiotic use. None of the subjects who received antibiotics received doxycycline, a tetracycline antibiotic known to cause black deposition in the thyroid gland (13). Other demographic characteristics were similar between the two groups.…”

Section: Resultsmentioning

confidence: 97%

Thyroid Function in Patients with Cystic Fibrosis: No Longer a Concern?

Lee

Chesdachai

Lee

et al. 2016

Thyroid

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Background: Development of goiter and hypothyroidism has been reported in patients with cystic fibrosis (CF) since the 1970s, especially when treated with iodine-based expectorants. With iodine-containing expectorants no longer in routine use, the prevalence of thyroid dysfunction in CF patients is unknown. This cross-sectional study assessed thyroid function status in a large cohort of CF patients. Methods: Sera from ambulatory subjects were obtained from an Institutional Review Board (IRB)-approved biorepository of patients seen at the Emory CF Center between January 1, 2011, and December 31, 2014. Sera from hospitalized subjects were obtained from banked specimens from an IRB-approved inpatient clinical trial. Demographics, forced expiratory volume in one second (FEV1), and medication use were assessed from medical records. Thyroid function tests were measured from the stored sera. Multivariate regression models assessed associations between covariates and thyrotropin (TSH), free thyroxine (fT4), and thyroid dysfunction risk. Results: A total of 89 subjects (54% male, 91% white, M age = 24.4 years, median FEV1 63%) were included in the analyses. One subject was on thyroid hormone replacement, 93% were on pancreatic enzyme replacement, and 68% received antibiotics within six months. None had computed tomography scans with intravenous contrast within six months. One patient had positive thyroid peroxidase (TPO) antibodies. Of the 87 subjects with measured TSH values, seven (8%) had abnormal levels (range 0.2-7.6 lIU/mL; one overt, four subclinical hypothyroidism, and two subclinical hyperthyroidism). Of the 56 subjects with measured fT4 values, 19 (34%) had slightly low levels (range 0.49-0.79 ng/dL; 17 isolated mild hypothyroxinemia). A positive correlation between age and body mass index (BMI; p < 0.001) and a negative correlation between age and FEV1 (p = 0.041) were seen. Age, sex, race/ethnicity, BMI, FEV1, hospitalization status, use of pancreatic enzyme or thyroid hormone replacement, recent antibiotic use, and TPO antibody positivity were not predictive of TSH, fT4, or thyroid dysfunction risk. Stratified analyses by hospitalization did not predict TSH or fT4. Conclusions: Although 24 (27%) of the patients had abnormal serum thyroid function tests, overt thyroid dysfunction was rare in this cohort of 89 patients with CF. The degree of hypothyroxinemia was marginal, likely due to nonthyroidal illness. There were no significant predictors of thyroid dysfunction.

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Section: Resultsmentioning

confidence: 97%

Thyroid Function in Patients with Cystic Fibrosis: No Longer a Concern?

Lee

Chesdachai

Lee

et al. 2016

Thyroid

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“…A recent review by Oertel and colleagues has identified 61 cases that have been reported to date [1]. Since the first report of black thyroid in human tissue [2], the etiology has been associated with minocycline ingestion for year or more [2, 3]. Although minocycline has been suggested as the cause of the pigmentation in many cases [4–6], it has also been noted to occur subsequent to infection [7], perhaps due to treatment with other tetracycline derivatives [3].…”

Section: Introductionmentioning

confidence: 99%

Black Thyroid Associated with Thyroid Carcinoma

Kandil

Khalek

Alabbas

et al. 2010

International Journal of Endocrinology

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Objective. Black thyroid is a rare pigmented change seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. There have been 61 reported cases of black thyroid. We are aware of 13 cases previously reported in association with thyroid carcinoma. This paper reports six patients with black thyroid pigmentation in association with thyroid carcinoma. Design. The medical records of six patients who were diagnosed with black thyroid syndrome, all of whom underwent thyroid surgery, were reviewed. Data on age, gender, race, preoperative fine needle aspiration biopsy (FNA), thyroid function levels, and pathology reports were collected. Main Outcome. The mean age was 60 years. There were 5 females, 4 of whom were African American. All patients were clinically and biochemically euthyroid. Black pigmentation was not diagnosed in preoperative FNA, and only one patient had a preoperative diagnosis of papillary thyroid carcinoma. The other patients underwent surgery and were found to have black pigmentation of the thyroid associated with carcinoma. Conclusions. FNA does not diagnose black thyroid, which is associated with thyroid carcinoma. Thyroid glands with black pigmentation deserve thorough pathologic examination, including several sections of each specimen.

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“…1 In addition to its effects on the thyroid, minocycline is known to cause blueblack pigmentation of the skin, teeth, nails, and bone, with cutaneous effects being the most commonly observed. 3 Classically, black thyroid has been associated with the administration of high doses of minocycline, with most patients using the drug for more than 1 year before being diagnosed as having black thyroid. 3 Classically, black thyroid has been associated with the administration of high doses of minocycline, with most patients using the drug for more than 1 year before being diagnosed as having black thyroid.…”

mentioning

confidence: 99%

Pathology Quiz Case 2: Diagnosis

2012

Arch Otolaryngol Head Neck Surg

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Black thyroid resulting from short-term doxycycline use: Case report, review of the literature, and discussion of implications

Cited by 22 publications

References 13 publications

Thyroid Function in Patients with Cystic Fibrosis: No Longer a Concern?

Thyroid Function in Patients with Cystic Fibrosis: No Longer a Concern?

Black Thyroid Associated with Thyroid Carcinoma

Pathology Quiz Case 2: Diagnosis

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