An Episode of Silent Thyroiditis in a Patient with Chronic Thyroiditis and Papillary Adenocarcinoma Following Alpha Interferon Treatment for Hepatitis C.

Katabami, Shigeo; Kamijo, Keita; Kodama, Toshinori; Fujisawa, Yasunori; Katanuma, Akio; Yachi, Akira

doi:10.1507/endocrj.40.311

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…35,36 This fact was not corroborated by our study, as well as by Muratori et al 20 and Stefanova-Petrova et al 21 It is important to highlight that thyroid dysfunction could result from a direct effect of IFN-α on thyroid cell function. 28,37,38 The higher prevalence of virus C genotype 1 in patients who developed hypothyroidism is not a consensus in the literature. Sachithanandan et al 13 have detected elevated TPOAb levels before and during therapy only in genotype 1 patients.…”

Section: Discussionmentioning

confidence: 99%

Virus C genotype predisposes to primary hypothyroidism during interferon-α treatment for chronic hepatitis C

Pavan¹,

Pavin²,

Gonçales³

et al. 2011

Braz J Infect Dis

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Objective: The treatment of the chronic hepatitis C (HCV) with α-interferon is associated with thyroid dysfunction (TD). The aim of this study was to evaluate thyroid function outcome among patients with chronic HCV under treatment with conventional interferon (IFN) or peguilated interferon (PEG-IFN) in association with ribavirin. Patients and Methods: We studied 293 patients with chronic HCV, submitted to drug therapy for 24 or 48 weeks. Initially, we evaluated FT4, TSH, TPOAb, TgAb, and continued to monitor FT4 and TSH every three months during therapy and six months thereafter. Results: At baseline, TD prevalence was 6.82% (n = 20); 6.14% hypothyroidism; 0.68% hyperthyroidism. TPOAb was present in 5.46% of euthyroid patients. Out of 273 euthyroid patients at baseline, 19% developed TD: 17.2% hypothyroidism; 1.8% hyperthyroidism; 5.1% destructive thyroiditis (DT). 90% of TPOAb-positive patients at baseline developed hypothyroidism vs 14.5% of TPOAb-negative patients (p < 0.001). On average, TD occurred after 25.8 ± 15.5 weeks of treatment. 87.2% of patients who developed hypothyroidism did so during the first therapeutic cycle (p = 0.004; OR = 3.52; 95% CI = 1.36-9.65). Patients infected with genotype 1 virus were 2.13 times more likely to develop hypothyroidism (p = 0.036; 95% CI = 1.04-4.38). Hypothyroid and DT patients presented higher TSH levels before-treatment than patients who had remained euthyroid (p < 0.001; p = 0.002, respectively). DT patients presented lower qALT (p = 0.012) than euthyroid patients. Conclusion: Hypothyroidism was the most frequent TD, especially during the first cycle of α-interferon. Genotype 1 virus was associated with a risk two times higher for developing the illness. There was no need to interrupt or to change HCV treatment. Therefore, approximately 34% of TD was transient.

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Section: Discussionmentioning

confidence: 99%

Virus C genotype predisposes to primary hypothyroidism during interferon-α treatment for chronic hepatitis C

Pavan¹,

Pavin²,

Gonçales³

et al. 2011

Braz J Infect Dis

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“…The mechanism by which IFN-a therapy induced thyroid dysfunction is unclear. IFN-a may act as an immunomodulatory agent leading to thyroid dysfunction in susceptible patients (6,8,(30)(31)(32). In addition, IFN could directly affect both thyroid hormone synthesis and secretion in vitro (33).…”

Section: Discussionmentioning

confidence: 99%

Virologic factors related to interferon-alpha-induced thyroid dysfunction in patients with chronic hepatitis C

Chuang

et al. 2000

European Journal of Endocrinology

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Objective: Hepatitis C virus (HCV), being reported to be associated with a high prevalence of serological markers of autoimmunity in HCV-infected patients, and possibly sharing partial sequences in amino acid segments with thyroid tissue antigens, may be associated with interferon-a (IFN-a)-induced thyroid dysfunction in chronic hepatitis C patients. We conducted this study to clarify the issue. Design and Methods: One hundred and fifty chronic hepatitis C patients with normal baseline thyroid function were treated with IFN-a 2a, 2b and n1 (3-6 million Units three times weekly for 24 weeks). Pretreatment sera were tested for HCV genotype and HCV RNA levels. Serum thyrotropin, total thyroxine and free thyroxine index were performed every 4 weeks for 24 weeks followed by every 8 weeks for another 24 weeks. Results: Twenty-one (14.0%) patients developed early thyroid dysfunction (abnormal thyroid function during the first 3 months of therapy). Female gender, lower HCV RNA levels, IFN-a n1 and a lower IFN-a dose were significantly associated with early thyroid dysfunction. On multivariate analysis, gender, IFN-a preparation and HCV RNA levels were the significant factors associated with early thyroid dysfunction. Seven (4.7%) patients developed thyroid dysfunction during the second 3 months of IFN-a therapy. Taken together, 18.7% patients developed thyroid dysfunction. Female, mixed HCV genotype infection and lower HCV RNA levels were significantly associated with thyroid dysfunction. However, only gender remained significantly associated with IFN-a-induced thyroid dysfunction in multivariate analysis. Conclusions:The virologic features of HCV may be associated with thyroid dysfunction in chronic hepatitis C patients treated with IFN-a. Nevertheless, gender still plays the most important role in IFN-a-induced thyroid dysfunction.

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“…Serum free T4 (FT4), free T3 (FT3) and TSH concentrations and antimicrosomal antibody (Mc Ab) and antithyroglobulin antibody (TgAb) were determined in the manner previously described [4].…”

Section: Endocrinologic Evaluationmentioning

confidence: 99%

Clinical Studies on Thyroid CT Number in Chronic Thyroiditis.

Kamijo

1994

Endocr J

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Abstract. The purpose of the present study is to investigate by a computed tomography (CT) thyroid CT number (Hounsfield units; H.U.) in chronic thyroiditis (CH).The correlation of the CT value with the concentration of KI solution in the test tube of thyroid phantom for thyroid scintigram was linear. No significant correlation between thyroid CT number and the urinary iodine concentration was also observed in 36 patients with CH. A mean thyroid CT number (± SD) of 81 ± 24 H.U. in 155 patients with CH was significantly (P<0.001) lower than 125 ± 18 H.U. in 95 normal subjects. The patients with CH could be arbitrarily divided into 3 groups according to the decrease in their thyroid CT number: normal (N) group (? 88 H.U.), moderately decreased (MD) group (70-87 H.U.) and the greately decreased (GD) group (<70 H.U.). There was a significant difference in the thyroid volume among 21.2±9.1 cm3 in the N group, 32.2± 18.1 in the MD group (P<0.05 vs. N group) and 43.6±23.3 in the GD group (P<0.01 vs. N and MD group). The mean serum TSH concentration of 38.95 ± 54.61 µU /ml in the SD group was significantly (P<0.01) higher than either 4.11 ± 3.64 in the MD group or 2.00± 1.43 in the N group. The serum TSH level in the MD group differed significantly (P<0.05) from that of the N group.Hypothyroidism characterized by low serum FT 4 (<0.8 ng/dl) and very high serum TSH was observed in none in the N group, in 2 (7.1%) of 28 cases in the MD group and in 16 (33.3%) of 48 cases in the GD group. And latent hypothyroidism characterized by an increase in serum TSH levels (? 5 µU / ml) and normal concentrations of thyroid hormones was found in 2 (5.1%) of 39 cases in the N group, 5 (17.9%) in the MD group and 16 (33.3%) of the GD group. There was a significant (P<0.005) difference in multiple chi-square analysis in the comparison between the GD group and the N group or MD group. The frequency of higher titers of antimicrosomal Ab and antithyroglobulin Ab seemed to be correlated with the amount of decrease in the thyroid CT number. In conclusion, there was a significant correlation between the thyroid CT number and the severity of chronic thyroiditis.

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An Episode of Silent Thyroiditis in a Patient with Chronic Thyroiditis and Papillary Adenocarcinoma Following Alpha Interferon Treatment for Hepatitis C.

Cited by 9 publications

References 16 publications

Virus C genotype predisposes to primary hypothyroidism during interferon-α treatment for chronic hepatitis C

Virus C genotype predisposes to primary hypothyroidism during interferon-α treatment for chronic hepatitis C

Virologic factors related to interferon-alpha-induced thyroid dysfunction in patients with chronic hepatitis C

Clinical Studies on Thyroid CT Number in Chronic Thyroiditis.

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