The nature of thyroid pathology in patients with drug-resistant tuberculosis
Relevance. Despite the improvement in the epidemiological situation of tuberculosis in the Russian Federation [1], the number of patients with MDR and XDR-tuberculosis in the Russian Federation and worldwide continues to increase [2,3]. It is known that the combination of second-line drugs (reserve group), such as prothionamide (ethionamide) in combination with PASK, can cause damage to the thyroid gland if taken for a long time [4]. According to the data of Belyaev E.N. et al. (2015), when treating tuberculosis with six anti-tuberculosis drugs of a reserve line in combination with perchlozone, adverse reactions from the endocrine system in the form of hypothyroidism are noted [5]. Objectives. To study the level of TSH in patients with tuberculosis receiving mandatory inclusion in the regimen of prothionamide (ethionamide) and PASK. To study the structural changes in the thyroid gland in patients with tuberculosis, receiving mandatory inclusion in the regimen of prothionamide (ethionamide) and PASK. Methods. The study was conducted on the basis of the participation of 20 tuberculosis patients being treated in the day hospital of the KUZ VO VOKPTD named after N.S. Pohvisneva in 2019, receiving a continuation phase with the obligatory inclusion of prothionamide (ethionamide) and PASK in the regimen. The study was conducted from September 2019 to December 2019. All patients excluded a history of thyroid disease, autoimmune thyroiditis. Complaints of headache, tendency to hypotension and bradycardia, edema, obstruction, pain in the joints were not noted. We have not previously consulted an endocrinologist. The study of thyroid function was assessed using the determination of TSH in blood plasma. In addition, a biochemical blood test was performed: lipid profile, creatinine, urea, transaminases. Structural changes in the thyroid gland were assessed using an ultrasound diagnostic apparatus. Results. When studying the level of TSH in the blood serum in 7 (35.00%) patients, an increase in the level of TSH with a maximum value of up to 7.9 mIU / ml was noted (reference values: 0.27-4.20 mIU / ml), in 13 ( 65.00%) of patients, the deviation of the TSH level was not recorded. Ultrasound examination of the thyroid gland showed focal changes in the form of cystic formations and nodules in 5 (25.00%) patients, diffuse in 5 (25.00%), and diffuse focal in 5 (25.00%). No thyroid pathology was revealed in 5 (25.00%) patients. Conclusion. Thus, in the treatment of tuberculosis with the obligatory inclusion of prothionamide (ethionamide) and PASK, it is necessary to monitor the TSH level in combination with ultrasound examination of the thyroid gland, followed by consultation with an endocrinologist for the timely detection and correction of hypothyroidism.