Acute exacerbation of Hashimoto's thyroiditis in a patient treated with dimethyl fumarate for multiple sclerosis: A case report

[helvella]

Another one to add to the list of medicines which potentially cause problems in those with thyroid issues. (We already have biotin on the list due to its interference will many blood tests - ironically, high dose biotin is also use in multiple sclerosis.)

Medicine (Baltimore). 2019 Apr;98(17):e15185. doi: 10.1097/MD.0000000000015185.

Acute exacerbation of Hashimoto's thyroiditis in a patient treated with dimethyl fumarate for multiple sclerosis: A case report.

Ciurleo R, Sessa E, Marino S, D'Aleo G, Bramanti P, Rifici C.

Abstract

INTRODUCTION:

Dimethyl fumarate (DMF) has been recently approved for first-line monotherapy of Multiple Sclerosis (MS). Its effects are due to mechanism modulating the immune system and activating antioxidative and neuroprotective pathways.

PATIENT CONCERNS:

A 59-year-old female patient affected by chronic Hashimoto's thyroiditis (HT) from 10 years was diagnosed with relapsing remitting MS in 2013. She started therapy with DMF in November 2016.

DIAGNOSIS:

After 2 months of therapy with DMF, the results of thyroid function test were abnormal. Thyroid ultrasonography confirmed the diagnosis of acute exacerbation of HT.

INTERVENTIONS:

This condition led to discontinuation of DMF therapy.

OUTCOME:

Two months after the interruption of DMF therapy, the findings of thyroid function test were within normal limits.

CONCLUSION:

The association of MS with autoimmune thyroid diseases supports a common immune-mediated pathogenic mechanism. We assume that the acute exacerbation of HT in our MS patient is associated not with the immunomodulatory effect of DMF but rather with its antioxidative mechanism. Constant monitoring of thyroid hormone levels should be recommended especially if the MS patients in treatment with DMF are affected by concomitant autoimmune thyroid diseases.

PMID: 31027063

DOI: 10.1097/MD.0000000000015185

ncbi.nlm.nih.gov/pubmed/310...

For those, like me, who went "What is DMF?":

Dimethyl fumarate (DMF) is the methyl ester of fumaric acid and is named after the earth smoke plant (Fumaria officionalis). DMF combined with three other fumaric acid esters (FAEs) is solely licensed in Germany as an oral therapy for psoriasis (trade name Fumaderm®). Since 2013, it has been used to treat adults with relapsing multiple sclerosis (trade name Tecfidera®). In 2017, a new oral formulation of DMF (trade name Skilarence®) was approved by the European Medicines Agency (EMA) for use in Europe as a treatment for moderate-to-severe plaque psoriasis. DMF is thought to have immunomodulatory properties without causing significant immunosuppression.

en.wikipedia.org/wiki/Dimet...

[thyr01d]

Thanks for this Helvella, it's very interesting. My conclusion is that it looks as if those of us with Hashimoto's may need to be wary of antioxidative effects, and many of the supplements we are advised to take are antioxidants, I'm thinking also of things like green tea.

Personally I have noticed that the more conscious I am of getting everything right, the worse I seem to be, and when away from home and unable/unwilling to avoid certain 'baddies', I seem to improve. Thought it was imagination and a 'holiday-effect', but perhaps not.