Int J Thyroidol.  2018 Nov;11(2):176-181. 10.11106/ijt.2018.11.2.176.

Methimazole-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in the Peripheral Nerves

• Kang MI
• Kim D

• KMID: 2448990
• DOI: http://doi.org/10.11106/ijt.2018.11.2.176

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis has been reported in Graves' disease patients treated with antithyroid drugs (ATDs), especially propylthiouracil. ATD-induced ANCA-associated vasculitis usually involved the kidneys followed by the respiratory organs and skin. The treatment of ANCA-associated vasculitis induced by ATDs is to stop ATD therapy immediately, which often leads to an overall good prognosis. We report a case of ANCA-associated vasculitis in the peripheral nerves of the lower extremities in a 66-year-old woman who was treated with methimazole (MMI) for Graves' disease. To our knowledge, this is the third case of peripheral nervous system (PNS) involvement of ATD-induced vasculitis and the first case of PNS vasculitis associated with MMI.

Keyword

ANCA-associated vasculitis; Antithyroid agents; Graves' disease; Methimazole

MeSH Terms

Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Antibodies, Antineutrophil Cytoplasmic
Antithyroid Agents
Female
Graves Disease
Humans
Kidney
Lower Extremity
Methimazole
Peripheral Nerves*
Peripheral Nervous System
Prognosis
Propylthiouracil
Skin
Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Antithyroid Agents
Methimazole
Propylthiouracil

Figure

• 

  Fig. 1 Clinical course and laboratory results upon admission. Fever and elevated C-reactive protein (CRP) levels improved shortly after methylprednisolone (Methylpd) administration and methimazole (MMI) withdrawal. Day 0 represents the day of admission. BT: body temperature, Cyclophos: cyclophosphamide, DC: discharge, OPD: outpatient department, RAI therapy: radioactive iodine therapy

• 

  Fig. 2 Follow-up thyroid function test results. After radioactive iodine therapy the patient was in a transient thyrotoxic state, but subsequently reached a euthyroid state without the need for any medication. The reference ranges of thyroid function tests were as follows: free T4 0.78–1.94 ng/dL (gray area), TSH 0.25–4.0 mIU/L. Adm: admission, Free T4: free thyroxine, TSH: thyrotropin, RAI therapy: radioactive iodine therapy

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