Guest guest Posted December 17, 2002 Report Share Posted December 17, 2002 Okay, you guys, calm down. I was afraid of causing a furor by mentioning this, but after due consideration, decided that it just wouldn't be right to keep the information to myself. Please understand the context: it is a RARE consequence, just as is agranulosis. Do not abruptly discontinue ATDs just because another rare danger is known. I'm not going to try to address questions about symptoms unless/until the person involved wishes to share this. Here is some of what Elaine said, as we anticipated some concern: " Again, a review of the literature shows only 56 moderate to severe cases of drug related illness from PTU and all cases resolved when the drug was withdrawn. And all were illnesses that occurred within a few weeks of starting PTU and even sooner if the drug was stopped and later started again. Another study says that long-term use of PTU causes the develop of P-ANCA, but again the antibodies decline when the drug is stopped. From everything I've found, I'd suspect that she's developed an additional autoimmune or other systemic disease if she stopped the PTU several months ago when she first contacted me. If she was still taking the PTU, I suppose a pulmonary related vasculitis could be the cause. " " In one case, a 14 year old girl, they though she may have had a preexisting IgA neuropathy, with acute pauci-immune glomerulonephritis (kidney disorder) secondary to PTU, or this may be the first description of an overlap syndrome of IgAN and ANCA vasculitis all cuased by PTU therapy. The article was in Pediatr Nephrol 2002 April by Winters MJ, et al, abstract on Pub Med Then there's a case of monozygotic triplets with hyperthyroidism who were on PTU. 2 developed a positive ANCA, suggesting a genetic factor that makes them susceptible to developing a pos ANCA while on PTU, much like the genetic predisposition seen in those people who develop drug related lupus. In another case, a 12 year old boy from Taiwan developed ANCA- positive vasculitis during PTU therapy for GD. His symptoms and signs were indistinguishable from anaphylactoid purpura. Symptoms resolved after discontinuation of PTU and immunosuppressant medication. 11 months follow-up he remains symptom free Probably the best reference is Frequency of appearance of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO_ANCA) in Graves' disease patients treated with PTU and the relationship between MPO_ANCA and clinical manifestiations' by Noh JY, Asari T, et al Clin Edocrinol (Oxf) 2001 May The other article I mentioned in is European J Endocrinol 2000 June and mentions finding 32 cases in the English literture. Prevalence of positive ANCA in patients receiving anti-thyroid medications, Gunton, JE, Stiel J, et al. You can attach this information to your post. Overall, I'd say the incidence of positive ANCA associated vasculitis is a rare complication similar to drug related lupus. But it is a reason for using the lowest dose necessary and a reason for using Tapazole over PTU when possible. It's also a symptom to watch for while on PTU. Hope this helps, Elaine " Quote Link to comment Share on other sites More sharing options...
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