Destructive thyroiditis followed by hypothyroidism associated with infliximab therapy

Area of Science:

• Endocrinology
• Dermatology
• Immunology

Background:

• Psoriasis is a chronic inflammatory skin condition often treated with biologic agents.
• Infliximab, a tumor necrosis factor-alpha inhibitor, is effective for moderate to severe psoriasis.
• Adverse effects of infliximab can include immune-related conditions, necessitating ongoing research into its impact on various organ systems.

Observation:

• A 57-year-old male with psoriasis developed destructive thyroiditis with transient thyrotoxicosis during 4 years of infliximab therapy.
• Initial presentation included thyrotoxicosis, with diagnostic findings of decreased thyroid iodine uptake and normal thyroid autoantibody levels.
• Thyroid function normalized with propylthiouracil and later levothyroxine, and resolved after infliximab discontinuation.

Findings:

• This case presents as the third reported instance of infliximab-associated thyroid disorder.
• The patient experienced transient thyrotoxicosis followed by hypothyroidism, both resolving after medication adjustments.
• Thyroid scintigraphy and antibody tests provided insights into the destructive nature of the thyroiditis.

Implications:

• This case highlights the importance of vigilant thyroid function monitoring in patients receiving infliximab therapy.
• Understanding infliximab's potential to induce thyroid dysfunction is critical for managing patients with psoriasis.
• Further research may elucidate the immunopathogenic mechanisms underlying infliximab-induced thyroiditis.