Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy

Andrade, Luís Jesuíno de Oliveira; Atta, Ajax Mercês; Atta, Maria Luiza Brito de Sousa; Mangabeira, Célia Neder Kalil; Paraná, Raymundo

doi:10.1590/s1413-86702011000400013

Cited by 25 publications

(29 citation statements)

References 20 publications

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“…The prevalence of TAs in female patients with chronic HCV infection was higher but was not significant compared with male patients. This observation was consistent with previous studies, which reported that there was no difference between females and males with respect to TAs before treatment (20,26 (27). IgG1 and IgG3 are more capable of binding to monocytes and neutrophils and activating the complement system than IgG2 and IgG4 (28).…”

Section: Discussionsupporting

confidence: 93%

“…The patients enrolled in our study (TD and WTD groups) had similar distributions by sex, age, and virological indicators (HCV genotype and viral load). It has been reported that lower ALT and increased TPOAb levels were more commonly found in CHC patients with TD than those without thyroid disorders (19,20). We observed similar trends between TD and euthyroid patients.…”

Section: Discussionsupporting

confidence: 84%

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The presence of thyroid peroxidase antibody of IgG2 subclass is a risk factor for thyroid dysfunction in chronic hepatitis C patients

Shao

Huo

Zhao

et al. 2013

European Journal of Endocrinology

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Objective: To investigate the prevalence of thyroid dysfunction (TD) and IgG subclasses of thyroid autoantibodies (TAs) and to determine the predictive factors of TD in chronic hepatitis C (CHC) patients. Design: Three hundred and twelve untreated hepatitis C virus-infected patients without a history of TD or treatment with thyroid hormones were enrolled in a cross-sectional study. Clinical and biological factors were statistically analyzed to determine the correlation between TD and this patient population. Results: The incidence of TD was 12.5% in CHC patients. Clinical hypothyroidism (5.8%) and subclinical hypothyroidism (3.8%) were more frequent than clinical hyperthyroidism (1.6%) and subclinical hyperthyroidism (1.3%). The percentage of TA-positive patients was significantly higher in people O60 years than in those %60 years (31.9 vs 18.6%; PZ0.042). Positive thyroid peroxidase antibody (TPOAb) was more frequent, and alanine aminotransferase (ALT) levels were lower in patients who displayed TD (TPOAb: 62.1 vs 10.8%, PZ0.000; ALT: 43.5 vs 51 IU/l, PZ0.046). The positive percentage of TPOAb IgG2 subclass in the TD group was significantly higher than that of patients without TD (66.7 vs 16.7%, PZ0.005). Multiple logistic regression analysis indicated that only TPOAb IgG2 subclass positivity was an independent risk factor for TD in CHC patients (odds ratioZ8; 95% CI: 1.225-52.246; PZ0.030). Conclusions: TPOAb IgG2 subclass positivity is a risk factor for TD in CHC patients before antiviral treatment. IgG2 subclass of TPOAb might play an important role in the presence of TD in CHC patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

The presence of thyroid peroxidase antibody of IgG2 subclass is a risk factor for thyroid dysfunction in chronic hepatitis C patients

Shao

Huo

Zhao

et al. 2013

European Journal of Endocrinology

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“…Thyroid dysfunction represents one of the commonest endocrine manifestations of chronic hepatitis C infection, exaggerated by interferon based treatment [4]. Changes in thyroid function are common side-effects occurring during antiviral therapy with interferon-alpha (IFN-α).…”

Section: Introductionmentioning

confidence: 99%

“…Changes in thyroid function are common side-effects occurring during antiviral therapy with interferon-alpha (IFN-α). In this way, the spectrum of thyroid diseases range from the production of isolated anti-thyroid antibodies to dysfunctions such as hypothyroidism, Graves' disease (GD), and destructive thyroiditis [4,5]. IFN-α therapy for HCV may induce thyroid changes or dysfunction in 2.5% to 20% of treated patients.…”

Section: Introductionmentioning

confidence: 99%

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Sub-Clinical Thyroid Disorders in Patients With Hepatitis C Before and After Conventional Treatment

Rahman¹,

Amir²,

Aziz³

et al. 2017

J Diabetes Metab

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Objective: Thyroid dysfunction represents one of the commonest endocrine manifestations of chronic hepatitis C infection, exaggerated by interferon based treatment. The purpose of this study was to assess the frequency of hepatitis C virus and sub-clinical thyroid disorder in patients with hepatitis C before and after treatment.Methods: This is an observational, cross sectional analysis conducted in Lyari general hospital and Abbasi Shaheed hospital from January 2009 to December 2015. Patients with a positive rt-PCR and genotype 3 were included in the study. After a positive rt-PCR, patients were screened by thyroid stimulating hormone before starting the treatment. All patients were given therapy of conventional interferons (3 million units thrice weekly) and ribavirin (800 mg per day in two divided doses) for a period of 6 months. Patient with normal TSH level was included and patients with a co-existing hepatitis B or D were excluded from the study. After 6 months of therapy all patients had a repeat rt-PCR to see the end treatment response to therapy and a thyroid stimulating hormone to screen for thyroid disorders.Results: A total of 129,430 patients have visited the medical outpatient department of which, 4069 were HCV RNA PCR positive. The prevalence of unrecognized hepatitis C Virus was 13.4% in the study population. The prevalence of sub-clinical thyroid disorders was 9%. Of which 6.5% had sub-clinical hypothyroidism and 2.5% had overt or subclinical hyperthyroidism. A total of 2196 patients were included in the analysis. Mean age was 36.22 ±10.01 years range from 16 to 63 years. Among all 36.9% were male and 5.1% were known diabetics. On the whole 14.8% were non-responders, 80.9% achieved an end treatment response and 4.3% lost to follow up. We observed an association between the post treatment TSH level and the ETR of HCV (p=0.015). A statistically significant difference (p<0.001; 95% CI -3.008-1.577) was observed in the thyroid stimulating hormone at the baseline and following the conventional interferon and ribavirin therapy for a period of 6 months. 388 (17.6%) patients had abnormal thyroid function tests after conventional interferon treatment. These 388 patients were further followed up for 6 months. Conclusion:In conclusion, this study results shows 13.4% prevalence of HCV in Karachi and the prevalence of sub-clinical thyroid disorders was 9%, of which 6.5% and 2.5% had overt hypothyroidism and hyperthyroidism respectively.

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Immunological dysfunction during or after antiviral therapy for recurrent hepatitis C reduces graft survival

et al. 2013

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Introduction Pegylated interferon and ribavirin (PEGIFN/RBV) therapy for recurrent hepatitis C after liver transplantation (LT) is associated with a lower sustained virological response (SVR) rate as well as more frequent side effects compared to non-transplant patients. We aimed to determine the incidence and clinical characteristics of LT recipients with recurrent hepatitis C who developed immunological dysfunction (ID) during or after PEG-IFN/RBV therapy and to assess its impact on patient and graft survival. Methods Seventy-four deceased donor LT recipients with histological recurrence of hepatitis C were treated with PEG-IFN/RBV from 1/00 to 12/08. ID was defined as biopsy-proven rejection or moderate plasma cell hepatitis. Patients were followed up until death, re-LT or 30 September 2011. Results Twelve patients (16 %) had ID, 8 (10.7 %) had cholestasis without ID, while 54 had no ID/cholestasis during or after discontinuation of PEG-IFN/RBV therapy. Biopsy-proven acute cellular rejection prior to (hazard ratio = 4.87, p = 0.009) and type of immunosuppression at the time of initiation of PEG-IFN/RBV were the only independent predictors of ID. Patients who were on tacrolimus at the time of initiation of PEG-IFN/RBV had a significantly lower risk of ID compared to those who were on cyclosporine (HR 0.254, p = 0.023). Patients with ID had a trend toward a lower SVR rate (25 vs. 54 %, p = 0.18) and a significantly higher rate of graft failure (33 vs. 4 %, p = 0.004) compared to patients with no ID/cholestasis. Conclusions ID is common during or after PEG-IFN/RBV therapy for recurrent hepatitis C and frequently associated with decreased graft survival, trending toward low rates of SVR. Careful monitoring of liver biochemistries during or after PEG-IFN/RBV therapy with a low threshold to biopsy patients and particularly those receiving cyclosporine-based immunosuppression may improve outcomes in these patients.

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Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy

Abstract: Thyroid dysfunction and autoimmune TD were observed during IFN-α and RIB therapy.

Cited by 25 publications

References 20 publications

The presence of thyroid peroxidase antibody of IgG2 subclass is a risk factor for thyroid dysfunction in chronic hepatitis C patients

The presence of thyroid peroxidase antibody of IgG2 subclass is a risk factor for thyroid dysfunction in chronic hepatitis C patients

Sub-Clinical Thyroid Disorders in Patients With Hepatitis C Before and After Conventional Treatment

Immunological dysfunction during or after antiviral therapy for recurrent hepatitis C reduces graft survival

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