Propylthiouracil and carbimazole associated‐antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves’ disease

Abstract

This study revealed a high prevalence of ANCA in treated patients with Graves' disease but not in those with Hashimoto's thyroiditis. Furthermore, within the Graves' disease population, ANCA development was associated with propylthiouracil usage to a greater extent than carbimazole. These findings suggest that the altered immune environment associated with autoimmune thyroid disease is not sufficient to develop ANCA but treatment with thionamides is important in promoting ANCA development.

Thionamides-Related Vasculitis in Autoimmune Thyroid Disorders: Review of Current Literature and Case Reports

“…This study suggested that it is PTU treatment, and not hyperthyroidism or autoimmunity, which induces ANCA production (Ozduman Cin et al, 2009). In agreement with this, ANCA prevalence is increased in Graves' disease, but not in patients with other autoimmune thyroid disease, such as Hashimoto thyroiditis (Harper et al, 2004). Furthermore, it has also been demonstrated that PTU administration is associated with ANCA positivity at a similar rate in both patient with Graves' disease and those with toxic multinodular goiter, suggesting that PTU but not Graves' disease itself is the most important factor for ANCA development (Yazisiz et al, 2008).…”

“…Also a case of polyneuropathy, with evidence of microvasculitis in nerve biopsy, was reported as associated to this drug administration (Leger et al, 1984). In a large cross-sectional study of 407 patients with Graves' disease, Harper et al reported that both PTU and carbimazole therapy were associated with an increases rate of ANCApositivity, although the risk in carbimazole-treated patients was smaller than in PTU-treated ones (15.9% and 33.3% respectively vs 4,6% of controls) (Harper et al, 2004). Its administration has also been related to the development of rare side effects, such as those described by Sève et al, who reported the first case of eosinophilic granulomatous vasculitis localized to the stomach in a patient with Graves' disease treated for five months with carbimazole, with complete resolution of clinical manifestations after drug dismission (Sève et al, 2005).…”

Auto-imunidade ANCA (Anticorpo Anti-Citoplasma de Neutrófilos) positiva induzida por propiltiouracil: relato de caso e revisão da literatura

“…A prevalência de ANCA-MPO nos usuários de drogas antitireoidianas varia de 25-60% nos pacientes tratados com PTU, e de 3,4% nos tratados com metimazol (29)(30)(31). Em uma análise, Sato e cols.…”

“…A proporção de pacientes positivos para este anticorpo aumenta com a duração da terapia, porém não há correlação com idade ou sexo (29). Da mesma forma, não foi relatado aumento da prevalência do ANCA em pacientes com tireoidite de Hashimoto (30).…”

The relationship between bone marrow characteristics and the clinical prognosis of antithyroid drug-induced agranulocytosis

“…Therefore, it may affect the microenvironment of bone marrow and inhibit the generation and differentiation of pluripotent hematopoietic stem cells. The immunological reactions include the immunoglobulin (Ig) E-mediated hypersensitivity reaction, drug-induced IgG and IgM responses, and antineutrophil cytoplasm antibodies (ANCA) associated immune injury, which might contribute to agranulocytosis [1,7,[12][13]. Bone marrow characteristics may be valuable in revealing the tion of the 33 cases, there were 15 cases with bone marrow active proliferation, 3 cases with hyperplasia and 2 cases with hypoplasia in type I, while 3 cases with hyperplasia and 10 cases with active proliferation were indentified in type II.…”