Hyperthyroidism May Complicate Asthma Treatment
WESTPORT, Jun 27 (Reuters Health) - Hyperthyroidism may exacerbate asthma and produce symptoms that can mimic the adverse effects of asthma medication, physicians from the Medical College of Wisconsin in Milwaukee report.
Drs. Michael C. Zacharisen and Jordan N. Fink describe the case of a 66-year old woman, who was referred because of worsening of previously mild, intermittent asthma. The only asthma medication she was using was albuterol as-needed.
Although no specific trigger was identified, spirometry was consistent with severe persistent asthma. The patient was prescribed flunisolide via metered dose inhaler (MDI), salmeterol MDI and a 7-day course of prednisone.
The woman's asthma symptoms resolved, but she complained of "jitteriness" and salmeterol was stopped and later continued at a reduced dose. She did well for 7 months and then complained again of "tremulousness." This was once more attributed to salmeterol. Salmeterol was stopped, as was an antihistamine-decongestant she had been taking.
Nevertheless, within days, the patient complained of a "racing pulse" and shortness of breath. A thyroid scan revealed uniform enlargement and a diagnosis of hypothyroidism was made. The condition was treated and "she improved dramatically," they report the March-April issue of Allergy and Asthma Proceedings.
The patient then restarted on salmeterol twice daily along with clemastine/pseudoephedrine and short-acting beta2-agonists as needed. Her asthma control improved gradually and after 6 weeks she became stable.
The researchers conclude that "physicians need to be aware of systemic conditions such as hyperthyroidism, where symptoms may masquerade as side effects of bronchodilator medication." By doing so, they add, "a prompt diagnosis can be made, thereby allowing early corrective action."
In an accompanying editorial, Dr. Guy A. Settipane, of Brown University School of Medicine, Providence, Rhode Island, agrees and points out that "the frequency of these two diseases occurring together in the same patient has probably been underreported."
Allergy and Asthma Proc 2000;21:71-77.
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