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Thyrotoxicosis Associated with Ustekinumab Treatment for Psoriasis. Case Rep Dermatol Med 2020; 2020:8868553. [PMID: 32908719 PMCID: PMC7450299 DOI: 10.1155/2020/8868553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
Biologic treatments have revolutionised the management of psoriasis in recent years; however, data on their safety profile in large populations and long-term effects are being gathered on an ongoing basis. Ustekinumab is a monoclonal antibody that targets interleukin-12/23 used in the treatment of moderate-to-severe psoriasis. Here, we report the case of a 32-year-old Caucasian gentleman who developed thyrotoxicosis following the commencement of ustekinumab treatment. Following control of thyroid status by the Endocrinology team, this recurred after recommencement of ustekinumab on two further occasions over a 5-year period. This is the second known reported association of this nature. Awareness of these possible adverse effects is imperative in managing patients and informing decision-making, and further long-term studies will help elucidate the precise safety profiles of biologic treatments.
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Nakagawa J, Fujikawa K, Akagi M, Nakaji K, Yasui J, Hanatani Y, Hara T, Mizokami A, Kawakami A. Subacute thyroiditis in a patient with psoriatic arthritis switched from secukinumab to adalimumab: a case report and literature review. Mod Rheumatol Case Rep 2020; 5:36-39. [PMID: 32731788 DOI: 10.1080/24725625.2020.1741116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 71-year-old Japanese female with psoriatic arthritis (PsA) was admitted for fever and neck pain. Her medication had been switched from secukinumab, an interleukin (IL)-17A inhibitor, to adalimumab, a tumour necrosis factor (TNF)-α inhibitor, due to secondary failure for PsA. She was diagnosed with subacute thyroiditis (SAT) on the basis of thyroid hormone levels and thyroid ultrasound findings. Her SAT symptoms improved with prednisolone administration (15 mg/day). Following the administration of ixekizumab, an IL-17A inhibitor, her PsA improved without SAT relapse. SAT mechanism associated with TNF inhibitors remains unknown, but cytokine imbalance may be involved.
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Affiliation(s)
- Jun Nakagawa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Midori Akagi
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Keita Nakaji
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Junichi Yasui
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Yumi Hanatani
- Department of Dermatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Toshihide Hara
- Department of Dermatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Akinari Mizokami
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Wei YA, Chuang WC, Hong CH. Subacute thyroiditis in a patient with psoriasis treated with a tumor necrosis factor-α
inhibitor. Int J Dermatol 2018; 57:869-871. [DOI: 10.1111/ijd.13941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yu-An Wei
- Department of Dermatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Wan-Chi Chuang
- Division of Endocrinology and Metabolism; Department of Internal Medicine; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Chien-Hui Hong
- Department of Dermatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Dermatology; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
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Senlis M, Ottaviani S, Gardette A, Palazzo E, Coustet B, Dieudé P. Subacute thyroiditis in psoriatic arthritis treated by adalimumab. Joint Bone Spine 2017; 84:745-746. [DOI: 10.1016/j.jbspin.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
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André R, Opris A, Costantino F, Hayem G, Breban M. Cytomegalovirus subacute thyroiditis in a patient treated by infliximab for psoriatic arthritis. Joint Bone Spine 2016; 83:109-10. [PMID: 26184533 DOI: 10.1016/j.jbspin.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 10/23/2022]
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Kawashima J, Naoe H, Sasaki Y, Araki E. A rare case showing subacute thyroiditis-like symptoms with amyloid goiter after anti-tumor necrosis factor therapy. Endocrinol Diabetes Metab Case Rep 2015; 2015:140117. [PMID: 25969738 PMCID: PMC4424874 DOI: 10.1530/edm-14-0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 11/22/2022] Open
Abstract
Anti-tumor necrosis factor (TNF)-α therapy is established as a new standard for the treatment of various autoimmune inflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter after anti-TNF-α therapy. A 56-year-old man with Crohn's disease presented with fever and a diffuse, tender goiter. To control the diarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patient reported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevated serum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed. The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter with posterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99m scintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resulting from subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but his thyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, another TNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain and fever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient's symptoms resolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloid deposition in the thyroid.
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Affiliation(s)
- Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Hideaki Naoe
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Yutaka Sasaki
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
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Yasuji I. Subacute thyroiditis in a patient with juvenile idiopathic arthritis undergoing etanercept treatment: a case report and review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0670-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pascart T, Ducoulombier V, Roquette D, Perimenis P, Coquerelle P, Maury F, Baudens G, Morel G, Deprez X, Flipo RM, Houvenagel E. Autoimmune thyroid disorders during anti-TNF alpha therapy: coincidence, paradoxical event or marker of immunogenicity? Joint Bone Spine 2013; 81:369-70. [PMID: 24387973 DOI: 10.1016/j.jbspin.2013.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/19/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, 59160 Lomme, France; Department of Rheumatology, Lille 2 University, Salengro Hospital, 59037 Lille, France.
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, 59160 Lomme, France
| | - Diane Roquette
- Department of Rheumatology, Lille 2 University, Salengro Hospital, 59037 Lille, France; Department of Rheumatology, Valenciennes Hospital Center, 59300 Valenciennes, France
| | - Pierrette Perimenis
- Department of Endocrinology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
| | - Pascal Coquerelle
- Department of Rheumatology, Béthune Hospital Center, 62660 Beuvry, France
| | | | | | - Gauthier Morel
- Department of Rheumatology, Valenciennes Hospital Center, 59300 Valenciennes, France
| | - Xavier Deprez
- Department of Rheumatology, Valenciennes Hospital Center, 59300 Valenciennes, France
| | - René-Marc Flipo
- Department of Rheumatology, Lille 2 University, Salengro Hospital, 59037 Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, 59160 Lomme, France
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Yasuji I. Subacute thyroiditis in a patient with juvenile idiopathic arthritis undergoing etanercept treatment: a case report and review of the literature. Mod Rheumatol 2012; 23:397-400. [PMID: 22669598 DOI: 10.1007/s10165-012-0670-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/08/2012] [Indexed: 11/25/2022]
Abstract
We report on a 24-year-old woman with juvenile idiopathic arthritis (JIA) who developed subacute thyroiditis (SAT) while being treated with etanercept. She had suffered from JIA for 12 years, and her arthritis proved refractory to treatment with ibuprofen, prednisolone, and methotrexate. For the past 5 years, the patient had been treated successfully with etanercept at 25 mg/week. The patient more recently complained of high fever and lassitude, and presented with anterior neck swelling and tenderness. Palpation of the thyroid gland revealed it to be warm, erythematous, tender, and diffusely swollen. Laboratory tests revealed an increased erythrocyte sedimentation rate and C-reactive protein level. Thyroid function tests revealed decreased levels of thyrotropin-stimulating hormone, increased levels of free triiodothyronine, free thyroxine, and thyroglobulin, and an absence of thyroid autoantibodies. Sonography showed a diffusely reduced predominantly hypoechoic thyroid gland. Unenhanced computed tomography of the neck showed a homogeneously and mildly reduced thyroid gland. Serum titers of several viruses were not significant and so were considered unlikely to be the pathogens. On the basis of these presented findings, we diagnosed SAT, and etanercept therapy was withdrawn. The patient was treated with antibiotics and an increased prednisolone dose was initiated. She became symptom free and showed improved laboratory test results within 2 weeks, and was euthyroid by 3 months. Three months later, the patient developed hypothyroidism, although 6 months further on, the patient was asymptomatic on prednisolone, methotrexate, and levothyroxine therapy. In conclusion, whether SAT is a specific adverse event in this case in response to etanercept remains unclear. Nevertheless, the possibility of SAT should be considered in such patients on etanercept treatment.
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Affiliation(s)
- Inamo Yasuji
- Department of General Pediatrics, Nihon University Nerima-Hikarigaoka Hospital, Nihon University of School Medicine, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, Japan 179-0072.
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