Antineutrophil Cytoplasmic Antibody–Positive Small-Vessel Vasculitis Associated with Antithyroid Drug Therapy: How Significant Is the Clinical Problem?
Abstract
Background: The aim of this review was to delineate the characteristics of antineutrophil cytoplasmic antibody (ANCA)–associated small-vessel vasculitis associated with antithyroid drugs (ATD). A PubMed search was made for English language articles using the search terms antithyroid drugs AND ANCA OR ANCA-associated vasculitis. Summary: The literature includes approximately 260 case reports of ANCA-associated small-vessel vasculitis related to ATD, with 75% of these associated with thiouracil derivatives (propylthiouracil [PTU]) and 25% with methyl-mercapto-imidazole derivatives (MMI/TMZ). The prevalence of ANCA-positive cases caused by ATD varied between 4% and 64% with PTU (median 30%), and 0% and 16% with MMI/TMZ (median 6%). Young age and the duration of ATD therapy were the main factors contributing to the emergence of ANCA positivity. Before ATD therapy initiation, the prevalence of ANCA-positive patients was 0–13%. During ATD administration, 20% of patients were found to be positive for ANCA. Only 15% of ANCA-positive patients treated with ATD exhibited clinical evidence of vasculitis, corresponding to 3% of all patients who received ATD. Clinical manifestations of ANCA-associated vasculitis related to ATD were extremely heterogeneous. When vasculitis occurred, ATD withdrawal was usually followed by rapid clinical improvement and a favorable prognosis. Conclusions: ANCA screening is not systematically recommended for individuals on ATD therapy, particularly given the decreasing use of PTU in favor of TMZ/MMI. Particular attention should be given to the pediatric population with Graves' disease who receive ATD, as well as patients treated with thiouracil derivatives and those on long-term ATD therapy.
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ANCA-positive vasculitis is more common in patients of Asian ethnicity, and the majority of reports come from Asia.
“ANCA-positive vasculitis is more common in patients of Asian ethnicity, and the majority of reports come from Asia (143).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [143]
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- Authors
- Balavoine, A.-S., Glinoer, D., Dubucquoi, S., & Wémeau, J.-L.
- Affiliations
- Centre Hospitalier Universitaire de Lille (FR)
- Centre Hospitalier Universitaire de Saint-Pierre (BE)
- Corresponding author
- Balavoine, Anne-Sophie
- ORCID
- Dubucquoi, Sylvain
- Venue
- Thyroid®
- Publisher
- SAGE Publications
- Published
- 2015-12
- Volume
- 25
- Issue
- 12
- Pages
- 1273-1281
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2121802847
- Cited by
- 65
- References
- 59
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 5 · 2020: 10 · 2019: 7 · 2018: 11 · 2017: 6 · 2016: 5 · 2014: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Keywords
- ANCA-associated vasculitis, small vessel vasculitis, antithyroid drugs, propylthiouracil, methimazole, drug-induced vasculitis, Graves' disease, pediatric patients, drug withdrawal
- MeSH terms
- Age Factors, Humans, Hyperthyroidism, Methimazole, Propylthiouracil, Antithyroid Agents, Time Factors, Prevalence, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
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