Effect of Rifampin on Thyroid Function Test in Patients on Levothyroxine Medication
Open accessAbstract
BACKGROUND: Levothyroxine (LT4) and rifampin (RIF) are sometimes used together; however, no clinical studies have assessed the effects of these drugs on thyroid function or the need to adjust LT4 dose. METHODS: We retrospectively reviewed the records of 71 Korean patients who started RIF during LT4 treatment. Clinically relevant cases that required dose adjustment according to the American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) guidelines were identified, and risk factors of increased LT4 dose were analyzed. RESULTS: After administering RIF, median serum thyroid-stimulating hormone (TSH) level (2.58 mIU/L, interquartile range [IQR] 0.21-7.44) was significantly higher than that before RIF (0.25 mIU/L, IQR, 0.03-2.62; P < 0.001). An increased LT4 dose was required for 50% of patients in the TSH suppression group for thyroid cancer and 26% of patients in the replacement group for hypothyroidism. Risk factor analysis showed that remaining thyroid gland (odds ratio [OR] 9.207, P = 0.002), the time interval between starting RIF and TSH measurement (OR 1.043, P = 0.019), and baseline LT4 dose per kg body weight (OR 0.364, P = 0.011) were clinically relevant variables. CONCLUSIONS: In patients receiving LT4, serum thyroid function test should be performed after starting RIF treatment. For patients with no remnant thyroid gland and those receiving a lower LT4 dose, close observation is needed when starting RIF and TB medication.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Lack of thyroid remnant, time interval between starting rifampin and TSH measurement, and baseline L-T4 dose/kg body weight were significant risks for undertreated hypothyroidism in patients starting rifampin.
“Lack of thyroid remnant, time interval between starting rifampin and TSH measurement, and baseline L-T4 dose/kg body weight were significant risks for UTH (47).”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [47]
In 71 L-T4-treated primary hypothyroidism patients who started rifampin, an increased L-T4 dose was required for 50% of 46 patients in the TSH-suppressive group and 26% of 25 patients in the replacement group.
“In 71 L-T4-treated PH patients who started the antituberculosis drug rifampin, an increased L-T4 dose was required for 50% of 46 patients (TSH-suppressive group) and 26% of 25 patients (replacement group) (47).”
From L-T4 therapy in the presence of pharmacological interferents (2020) · cites this paper as [47]
Treatments with phenobarbital, phenytoin, carbamazepine, and rifampin induce an increase in the levels of the enzyme responsible for the glucuronidation of LT4.
“Treatments with phenobarbital, phenytoin, carbamazepine, and rifampin induce an increase in the levels of the enzyme responsible for the glucuronidation of LT4 [ 116 , 117 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [117]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., Pessah-Pollack, R., Singer, P. A., & Woeber, K. A. (2012) · Endocrine Practice · doi:10.4158/ep12280.gl · Cited by 1,567 · see citing works
Fish, L. H., Schwartz, H. L., Cavanaugh, J., Steffes, M. W., Bantle, J. P., & Oppenheimer, J. H. (1987) · New England Journal of Medicine · doi:10.1056/nejm198703263161302 · Cited by 353 · see citing works
Inhibition of Cytochrome P450 (CYP450) Isoforms by Isoniazid: Potent Inhibition of CYP2C19 and CYP3A
Desta, Z., Soukhova, N. V., & Flockhart, D. A. (2001) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.45.2.382-392.2001 · Cited by 180 · see citing works
Update on rifampin, rifabutin, and rifapentine drug interactions
Baciewicz, A. M., Chrisman, C. R., Finch, C. K., & Self, T. H. (2012) · Current Medical Research and Opinion · doi:10.1185/03007995.2012.747952 · Cited by 178 · see citing works
Cho, H.-J., Koh, W., Ryu, Y.-J., et al. (2007) · Tuberculosis · doi:10.1016/j.tube.2007.05.012 · Cited by 173 · see citing works
Self-citationSabbagh, A., Darlu, P., Crouau‐Roy, B., & Poloni, E. S. (2011) · PLoS ONE · doi:10.1371/journal.pone.0018507 · Cited by 161 · see citing works
Reitman, M. L., Chu, X., Cai, X., Yabut, J. A., Venkatasubramanian, R., Zajic, S. C., Stone, J. A., Ding, Y., Witter, R., Gibson, C. R., et al. (2010) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2010.271 · Cited by 156 · see citing works
Update on Rifampin and Rifabutin Drug Interactions
Baciewicz, A. M., Chrisman, C. R., Finch, C. K., et al. (2008) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e31814a586a · Cited by 141 · see citing works
Yamashita, F., Sasa, Y., Yoshida, S., Hisaka, A., Asai, Y., Kitano, H., Hashida, M., & Suzuki, H. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070330 · Cited by 102 · see citing works
Current Status and Future Perspectives in Differentiated Thyroid Cancer
Kim, T. Y., Kim, W. G., Kim, W. B., & Shong, Y. K. (2014) · Endocrinology and Metabolism · doi:10.3803/enm.2014.29.3.217 · Cited by 84 · see citing works
Self-citationInduction of cytochrome P450 enzymes: a view on human in vivo findings
Hukkanen, J. (2012) · Expert Review of Clinical Pharmacology · doi:10.1586/ecp.12.39 · Cited by 73 · see citing works
Jung, J. A., Lee, S., Kim, T., et al. (2015) · Drug Design Development and Therapy · doi:10.2147/dddt.s87131 · Cited by 54 · see citing works
Self-citationRelling, M. V. (1989) · PubMed · Cited by 53 · see citing works
Complete Sequencing of a Genetic Polymorphism in NAT2 in the Korean Population
Lee, S., Lee, K., Ki, C., Kwon, O. J., Kim, H. J., Chung, M. P., Suh, G. Y., & Kim, J.-W. (2002) · Clinical Chemistry · doi:10.1093/clinchem/48.5.775 · Cited by 50 · see citing works
Self-citationISLEY, W. L. (1987) · Annals of Internal Medicine · doi:10.7326/0003-4819-107-4-517 · Cited by 46 · see citing works
Interaction between rifampin and levothyroxine
NOLAN, S. R., SELF, T. H., & NORWOOD, J. M. (1999) · Southern Medical Journal · doi:10.1097/00007611-199905000-00018 · Cited by 42 · see citing works
Influence of rifampicin on thyroid gland volume, thyroid hormones, and antipyrine metabolism
Christensen, H. R., Simonsen, K., Hegedüs, L., et al. (1989) · European Journal of Endocrinology · doi:10.1530/acta.0.1210406 · Cited by 18 · see citing works
Rifampin-induced hypothyroidism
Takasu, N., Kinjou, Y., Kouki, T., et al. (2006) · Journal of Endocrinological Investigation · doi:10.1007/bf03344165 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Burch, H. B. (2019) · New England Journal of Medicine · doi:10.1056/nejmra1901214 · Cited by 164 · see citing works
Caron, P., Grunenwald, S., Persani, L., Borson-Chazot, F., Leroy, R., & Duntas, L. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-021-09691-9 · Cited by 53 · see citing works
Drugs and Other Substances Interfering with Thyroid Function
Montanelli, L., Benvenga, S., Hegedüs, L., Vitti, P., Latrofa, F., & Duntas, L. H. (2018) · Endocrinology · doi:10.1007/978-3-319-45013-1_27 · Cited by 18 · see citing works
L-T4 therapy in the presence of pharmacological interferents
Benvenga, S. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.607446 · Cited by 13 · see citing works
“In 71 L-T4-treated PH patients who started the antituberculosis drug rifampin, an increased L-T4 dose was required for 50% of 46 patients (TSH-suppressive group) and 26% of 25 patients (replacement group) (47).”
BackgroundInfluential
- Authors
- Kim, H. I., Kim, T. H., Kim, H., Kim, Y. N., Jang, H. W., Chung, J. H., Moon, S. M., Jhun, B. W., Lee, H., Koh, W.-J., & Kim, S. W.
- Affiliations
- Samsung Medical Center (KR)
- Sungkyunkwan University (KR)
- Corresponding author
- Koh, Won-Jung
- Kim, Sun Wook
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-01-12
- Volume
- 12
- Issue
- 1
- Pages
- e0169775
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5231266
- OpenAlex
- W2572546344
- Cited by
- 16
- References
- 19
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 3
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- rifampicin, levothyroxine, thyroid function tests, thyroid-stimulating hormone, levothyroxine dose adjustment, drug interactions, hypothyroidism, thyroid cancer, TSH suppression
- MeSH terms
- Adult, Female, Humans, Hypothyroidism, Male, Middle Aged, Retrospective Studies, Rifampin, Risk Factors, Thyroid Function Tests, Thyroid Gland, Thyrotropin, Thyroxine, Logistic Models, Odds Ratio
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
