An unexpected case of hypothyroidism in a young female patient undergoing first-line anti-tuberculosis therapy for pulmonary tuberculosis

Hypothyroidism, once considered a rare adverse effect of anti-tuberculosis (TB) medication, is increasingly observed in patients undergoing second-line therapy for multidrug-resistant tuberculosis (MDR-TB). This study discusses a case involving a 17-year-old female patient who presented to the emergency department with sub-acute intestinal obstruction secondary to pulmonary TB. She underwent an exploratory laparotomy, during which routine investigations revealed elevated thyroid-stimulating hormone (TSH) levels. A week later, a second laparotomy was performed under general anaesthesia. Postoperatively, facial puffiness was noted, prompting a repeat TSH test, which indicated a significant increase from the initial levels. The diagnosis was revised to hypothyroidism potentially related to anti-tuberculosis therapy (ATT). While existing literature predominantly associates hypothyroidism with second-line anti-TB medications in MDR-TB patients, this study suggests a potential link between first-line ATT and hypothyroidism. This finding underscores the importance of monitoring TSH levels in patients on first-line anti-TB drugs.