Prolong QTc Interval in Ethionamide-Induced Hypothyroidism in the Treatment of Multidrug Resistant Tuberculosis (MDR TB)

https://doi.org/10.22146/actainterna.98166

Dekritiana Dian Pratiwi(1*), Eko Budiono(2)

(1) Internal Medicine Residency Program, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital
(2) Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital
(*) Corresponding Author

Abstract


Background. Ethionamide, as part of multidrug resistant tuberculosis (MDR TB) treatment, is an antibiotic classified by WHO as a second-line drug with bactericidal property. Administration of ethionamide therapy is associated with the incidence of hypothyroidism in MDR TB patients. The resulting hypothyroidism can be a factor that triggers QTc interval prolongation on electrocardiogram (ECG) during anti-tuberculosis treatment

Case Presentation. A 77-year-old man with a history of pulmonary TB treatment one year ago, returned to undergo the intensive phase of pulmonary TB treatment for two months. Sputum evaluation at the end of the phase showed positive smear results, and the patient was diagnosed with MDR TB after further examination. Before starting MDR TB treatment, an initial ECG examination (QTc interval 0.41 seconds), TSH, and FT4 level were found to be within normal limits. MDR TB regimen including ethionamide 750 mg/day was given for the treatment. In the third month of treatment, the patient was diagnosed with hypothyroidism suspected to be related to ethionamide. In the seventh month of treatment, the patient complained of sudden weakness and QTc interval prolongation in the ECG (0.48 seconds). Ethionamide was stopped and the ECG was evaluated. No QTc interval prolongation was found after stopping ethionamide.

Conclusion. This case emphasizes the importance of monitoring side effects arising from anti-tuberculosis treatment, especially ethionamide. Accuracy in diagnosing and following up the side effects of ethionamide administration in MDR TB patients is necessary to prevent worse cardiac events.


Keywords


Ethionamide, QTc interval, hypothyroidism, MDR TB

Full Text:

PDF


References

World Health Organization. 2017. Global Tuberculosis Report 2017. World Health Organization, Geneva.

World Health Organization. 2016. WHO Treatment Guidelines for Drug-resistant Tuberculosis 2016 Update. World Health Organization, Geneva

McDonnel, M. E., Braverman, L. E., Bernardo, J. 2005. Hypothyroidism Due to Ethionamide. N Engl J Med 26(352): 2757-59.

Shojaie, M., Eshraghian, A. 2008. Primary Hypothyroidism Presenting with Torsades de Pointes Type Tachycardia: A Case Report. BioMed Central 289: 1-4.

Schaaf, S. H., Thee, S., Van der Laan, L., Hesseling, A. C., Garcia-Prats, A. J. Adverse Effects of Oral Second-line Antituberculosis Drugs in Children. 2016. Expert Opinion on Drug Safety 15(10): 1369-81.

European Medicine Agency. 2005. The Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrihythmic Drugs. European Medicine Agency, London.

Bakiner, O., Ertorer, M. E., Haydardedeoglu, F. E., Bozkirli, E., Tutuncu, N. B., Demirag, N. G. 2008. Subclinical Hypothyroidism Is Characterized by Increased QT Interval Dispersion among Women. Med Princ Pract 17: 390-4.

Galetta, F., Franzoni, F., Fallahi, P., Tocchini, L., Braccini, L., Santoro, G., Antonelli, A. 2008. Changes in Heart Rate Variability ang QT Dispersion in Patients with Overt Hypothyroidism. European Journal of Endocrinology 158: 85-90.

Harausz, E., Cox, H., Rich, M., Mitnick, C. D., Zimetbaum, P., Furin, J. 2015. QTc Prolongation and Treatment of Multidrug-resistant Tuberculosis. Int J Tuberculosis Lung Dis 19(4): 385-91.



DOI: https://doi.org/10.22146/actainterna.98166

Article Metrics

Abstract views : 154 | views : 89

Refbacks

  • There are currently no refbacks.




Copyright (c) 2024 Acta Interna: The Journal of Internal Medicine

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Acta Interna The Journal of Internal Medicine Indexed by:

 

 Indonesia Onesearch Google Scholar IPI Indonesian Publication Index

 website statistics View My Stats  

 

 

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.