The onset of antineutrophil cytoplasmic antibody-associated vasculitis immediately after methimazole was switched to propylthiouracil in a woman with Graves’ disease who wished to become pregnant

摘要: Propylthiouracil (PTU) is recommended as a first-line antithyroid drug (ATD) during first trimester organogenesis in pregnancy because recent evidence suggests that methimazole (MMI) may be associated with congenital anomalies. However, PTU more commonly causes myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, which usually occurs prolonged treatment, compared MMI. We report case of MPO-ANCA-associated vasculitis 35-year-old woman Graves'disease. Although her thyroid function could maintained euthyroid by MMI, ATD was switched to she wished become pregnant. The patient presented flu-like symptoms 8 days after starting and developed hemoptysis dyspnea at 22 days. Her MPO-ANCA titer 21 ELISA units (EUs) before treatment but increased 259 EUs treatment. clinical condition improved the discontinuation immunosuppressive therapy. This indicated occurred within several weeks initiation this side effect caused change from MMI PTU. Thus, our observation patients treated should carefully monitored for titers variable manifestations regardless period administration.