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| Abstaining Opioid Drugs as a Possible Risk Factor for Graves’ Disease |
| Shahin Banaei-Boroujeni1*, Azam Ghanei2, Golnaz Malekzadeh3, Mehdi Mirzaei-Alvijeh3 and Ehsan Zarepur3 |
| 1Shahid Sadoughi University of Medical Sciences, Yazd, Iran |
| 2Internal medicine department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran |
| 3Student research committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran |
| *Corresponding author: |
Shahin Banaei-Boroujeni
Shahid Sadoughi University
of Medical Sciences,
Yazd, Iran
Tel: 09356506938
E-mail: shbanaei@gmail.com |
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| Received July 10, 2012; Accepted August 08, 2012; Published August 10, 2012 |
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Citation: Banaei-Boroujeni S, Ghanei A, Malekzadeh G, Mirzaei-Alvijeh M, Zarepur
(2012) Abstaining Opioid Drugs as a Possible Risk Factor for Graves’ Disease. J
Addict Res Ther 3:131.
doi:10.4172/2155-6105.1000131 |
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| Copyright: © 2012 Banaei-Boroujeni S, et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited. |
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| Abstract |
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| Introduction: Graves’ disease is an autoimmune disease with obscure etiology. It may be associated with an
underlying emotional stress of any kind. On the other hand abstaining opioid drugs’ addiction is a major stress that can
develop this disease. Confronting several patients who were attacked by Graves’ disease, with the history of opioid
abstinence led us to investigate them more and report the findings. |
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| Methods: In this case series study 46 patients who were addicted to opioid drugs and have abandoned it less than
9 months from the admission time to endocrinologist were investigated. They all presented the signs and symptoms
of Graves’ disease. Thyroid function tests consist of T3, T4 and TSH were measured for each patient and compared
against the ones before opioid abstinence. Statistical analysis was performed by using T- Test and SPSS 18.0 software. |
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| Results: 46 patients, which include 2 women and 44 men were studied. The lab results before opioid abstinence
confirmed that all were euthyriod. The serum level of T3 increased from 126.3026 ± 34.2356 ng/dl to 311.3696 ±
79.80932 ng/dl after opioid abstinence, this level for T4 also increased from 8.1130 ± 1.54684 ng/dl to 18.4674 ± 3.5589
ng/dl. The difference between thyroid hormone before and after opioid abstinence was statistically significant (P<0.05).
The serum level of TSH decreased from 1.3457 ± 0.68043 ng/dl to 0.0289 ± 0.0294 ng/dl which was also statistically
significant (P<0.05). |
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| Conclusion: Opioid drugs’ abstinence may develop Graves’ disease. More investigation is suggested. |
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| Introduction |
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| Graves’ disease is a thyroid auto immune disease which is the
most prevalent cause of hyper thyroidism in adults [1]. The etiology
of this disease remains obscure but is associated to TSI antibody [2].
According to the results of some research it is an autoimmune disease
in which IgG is produced and further bound to TSH receptors. As the
result thyroid hyperplasia, thyroid hypertrophy and rise in hormone
secretion will come to the fore. On the other hand interferon γ secreted
by T-cells increases TSH receptors and worsens auto immune reaction
toward thyroid [3]. |
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| Graves’ disease is more common in women than men (2% in
women against 0.2% in men) [4]. It is presented by symptoms of loss
of weight, over activity, palpitation, sweating, fatigue, hand tremor,
decreased libido, dermatopathy, menstrual disorder (mostly oligo
menorrhea) and the signs of bilateral diffuse enlargement of thyroid,
soft to firm consistency and sometimes bruit auscultation. In addition
ophtalmopathy is much more prevalent than other clinical presentations
of this disease [5]. |
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| The potential risk factors of this disease can be referred to genetic
susceptibility, infection, stress, pregnancy, irradiation, iodine and drugs [4]. |
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| Addiction is one of the biggest disasters of our today’s society,
especially among youth [6]. This social disorder came to exist from
years ago. Consuming opioid drugs causes short term euphoria, but it
has irrecoverable complications in long term [7]. |
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| Opioid drugs and its derivatives affect different organs of the body
in various ways. These ways are mostly recognized but, its adverse
effects are still vague. In regard to high prevalence of addiction in our
country considering this critical issue is highly required [8]. |
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| The effect of opioid drugs’ abstinence which may develop thyroid
disorder is not declared but confronting several cases of Graves’ disease
with the history of opioid drugs’ abstinence, led us to investigate them
more and report the findings. |
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| Methods |
| |
| In this case series study 46 patients who were addicted to opioid
drugs and have abandoned it less than 9 months from the admission
time to endocrinologist were investigated. None of these patients
were smoker simultaneous to the addiction. The results of laboratory
assessment during one year before opioid drugs’ abstinence confirmed
that all were Euthyriod. In addition HBS Ag, HCV Ab and HIV Ab of
all patients were reported as negative. |
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| These patients attended endocrine clinic of Shahid Sadoughi
University of medical sciences in the year 2010 to 2012 with the
complaints of loss of weight, palpitation, heat intolerance, sweating and
anxiety. The physical exam revealed diffuse enlargement of thyroid in
addition to ophtalmopathy. None of the patients had the risk factors
of Graves’ disease mentioned before. Thyroid function tests consist
of measuring serum level of T3, FT4I, and TSH were applied for each
patient to evaluate the presence of thyroid disease (immune fluoro
metric assay TSH ultra, Perkin Elmer Italia SP, Monza, Italy was used
to measure TSH and Autoanalyzer Immulite 2000 or Centaurus CDPC
limited, San Jaun Capistranto, CA were used to measure T3 and FT4I ).
Anti TPO was also measured to investigate the autoimmune base of
thyroid disease (RIA kit, Becton Dickinson and Co., Franklin Lakes,
NJ, USA was used to measure Anti TPO level). The lab results were compared against the ones they’ve had before opioid drugs’ abstinence
using SPSS software, 18th version and paired T-Test. P value less than
0.05 considered to be significant. |
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| Results |
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| 46 patients, which include 44 men (95.65 %) and 2 women (4.35%)
with the mean age of 35.1089 ± 6.10001 years old were investigated. The
mean period of opioid drug abstinence was 6.3043 ± 2.3081 months.
The comparison between the results of lab tests before and after opioid
drugs’ abstinence indicates a statistically significant increase in the
serum level of T3 (P<0.001).The mean serum level of T3 before and after
opioid drugs’ abstinence was 126.3026 ± 34.2356 ng/dl and 311.3696 ±
79.80932 ng/dl respectively. The mean serum level of T4 before opioid
drugs’ abstinence was 8.1130 ± 1.54684 ng/dl which then increased
to 18.4674 ± 3.5589 ng/dl after abstinence which was also statistically
significant (P<0.001). |
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| The mean serum level of TSH decreased from 1.3457 ± 0.68043 ng/
dl before opioid drugs’ abstinence to 0.0289 ± 0.0294 ng/dl after it. The
difference between them was statistically significant (P<0.001). |
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| The mean serum level of Anti TPO in patients after presenting
Graves’ sign and symptoms was 211.9783 ± 134.64 which was much
more higher than its normal range (<15). There was no data about the
serum level of Anti TPO before opioid drugs’ abstinence. |
|
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| Discussion |
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| In our study 46 patients who were addicted to opioid drugs and
confronted the symptoms such as palpitation, sweating, heat intolerance,
loss of weight and etc. less than nine months from the time of opioid
drug abstinence were investigated. The lab results indicated significant
difference in the level of T3, T4 and TSH before and after abstaining
addiction. In regard to signs, symptoms and lab results, Graves’ disease
is highly suggested. Graves’ disease is an auto immune disease which
the etiology is still obscure [2]. One of the most susceptible risk factors
in this disease is any kind of emotional stress [4]. Opioid withdrawal
can be an origin of stress for opioid addicted patients [9]. Therefore the
stress that stem from opioid withdrawal may be an underlying cause of
Graves’ disease. |
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| In some previous studies malfunction of immune system due to
opioid drugs addiction is mentioned [10,11]. In other words immune
system in addicted patients is suppressed. After ceasing its consumption
this inhibitory effect may be eliminated that can lead to improper and
over response of immune system, resulting in Grave’s disease. |
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| The other reason which can explain the onset of Graves’ disease is
the prevalence between genders. This disease is more prevalent among
women than men, because of protective and inhibitory effect of serum
androgens in men [4]. On the other hand a variety of studies indicated
that opioid drugs can lead to hypogonadism and decreasing the serum
level of androgens in men [12-17]. So it can be a predisposing factor for
incidence of Graves’ disease. |
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| In some previous studies high prevalence of auto immune diseases
between opioid addicted patients is discussed because of the more
viral and bacterial infection among them, which may make their body
susceptible to auto immune diseases [18]. |
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| In conclusion this study was a report of 46 opioid drugs addicted
patients who were attacked with Graves’ disease after the abstinence.
More investigation is required to prove the relation between opioid
consumption and its withdrawal with this disease, so it is suggested to survey on the possible effective factors of Graves’ disease in prospective
studies. |
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| Acknowledgements |
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| This study was supported by research grant from Research Deputy of
Shahid Sadoughi University of Medical Sciences. Thereby their support is greatly
appreciated. |
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| References |
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