Thyroid hormonal disturbances related to treatment of hepatitis C with interferon-alpha and ribavirin

Abstract

OBJECTIVE:To characterize thyroid disturbances induced by interferon-alpha and ribavirin therapy in patients with chronic hepatitis C.INTRODUCTION:Interferon-alpha is used to treat chronic hepatitis C infections. This compound commonly induces both autoimmune and non-autoimmune thyroiditis.METHODS:We prospectively selected 26 patients with chronic hepatitis C infections. Clinical examinations, hormonal evaluations, and color-flow Doppler ultrasonography of the thyroid were performed before and during antiviral therapy.RESULTS:Of the patients in our study, 54% had no thyroid disorders associated with the interferon-alpha therapy but showed reduced levels of total T3 along with a decrease in serum alanine aminotransferase. Total T4 levels were also reduced at 3 and 12 months, but free T4 and thyroid stimulating hormone (TSH) levels remained stable. A total of 19% of the subjects had autoimmune interferon-induced thyroiditis, which is characterized by an emerge of antithyroid antibodies or overt hypothyroidism. Additionally, 16% had non-autoimmune thyroiditis, which presents as destructive thyroiditis or subclinical hypothyroidism, and 11% remained in a state of euthyroidism despite the prior existence of antithyroidal antibodies. Thyrotoxicosis with destructive thyroiditis was diagnosed within three months of therapy, and ultrasonography of these patients revealed thyroid shrinkage and discordant change in the vascular patterns.DISCUSSION:Decreases in the total T3 and total T4 levels may be related to improvements in the hepatocellular lesions or inflammatory changes similar to those associated with nonthyroidal illnesses. The immune mechanisms and direct effects of interferon-alpha can be associated with thyroiditis.CONCLUSION:Interferon-alpha and ribavirin induce autoimmune and non-autoimmune thyroiditis and hormonal changes (such as decreased total T3 and total T4 levels), which occur despite stable free T4 and TSH levels. A thyroid hormonal evaluation, including the analysis of the free T4, TSH, and antithyroid antibody levels, should be mandatory before therapy, and an early re-evaluation within three months of treatment is necessary as an appropriate follow-up.

Factors Associated with Self Care Practices among Patients with Hepatitis C Virus

“…The present study revealed that more than one third of patients were in the age group of 41-50 years. This finding agrees with Branndt (2010) (27) and Danilova et al (2011) (28) . They illustrated that the prevalence rate of HCV is higher in old persons than in younger one.…”

Thyroid disorders associated with hepatitis C or interferon based therapies

“…Danilovic et al 9 prospectively selected 26 patients with chronic HCV infections to investigate thyroid disturbances induced by IFN-α and ribavirin thera-py. Of all patients, 54% had no thyroid disorders associated with the IFN-α therapy.…”

“…Additionally, 16% had non-autoimmune thyroiditis, which characterized by destructive thyroiditis or subclinical hypothyroidism, and 11% of patients who had TAb's prior to therapy remained in a state of euthyroidism. 9 In a recent study from Turkey showed that de novo incidence of thyroid dysfunction (TD) was found to be 16.8% among the 119 chronic HCV patients receiving pegylatedinterferon plus ribavirin.10 Similarly, a clinical study also showed that 11.5% of patients developed TD, 85.3% of these patients presented with subclinical TD, and 14.7% of them developed overt thyroiditis, at the end of the IFN-α based therapy. The study also showed that 67.8% of them the thyroid function spontaneously returned to normal in the six months of follow-up and only 4.4% had persistent overt TD symptoms after the 24 month follow-up period.11 The likelihood of TD development during the treatment varies between 5.5% and 27.8% according to different studies.…”

Thyroid disturbance related to chronic hepatitis C infection: role of CXCL10

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The associaTion between chronic hepatitis C (HCV) infection and thyroid autoimmune disorders (AITD) is controversial, but may occur or worsen during alpha-interferon treatment [1]. A large study observed slightly increased risk for thyroiditis in HCV-infected patients (hazard ratio = 1.06, 95% CI = 1.01-1.11) [2] and a recent review suggested a weak association in comparisons to hepatitis B (HBV) infected and control populations (odds ratio = 1.6, 95% CI=1.4-1.9).

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