Journal Information
Vol. 15. Issue 4.
Pages 377-381 (July - August 2011)
Share
Share
Download PDF
More article options
Vol. 15. Issue 4.
Pages 377-381 (July - August 2011)
Brief communication
Open Access
Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy
Visits
2557
Luis Jesuino de Oliveira Andrade1,
Corresponding author
luis_Jesuino@Yahoo.Com.Br

Correspondence to: Rua Nações Unidas, 511, Centro 45.600-673, Itabuna, Bahia, Brazil. Phone: +55 (73) 3212-1511.
, Ajax Mercês Atta2, Maria Luiza Brito de Sousa Atta3, Célia Neder Kalil Mangabeira4, Raymundo Paraná5
1 Medicine; Professor, School of Medicine, Universidade Estadual de Santa Cruz (UESC), BA, Brazil
2 Immunology; Head Professor, School of Pharmacy, Universidade Federal da Bahia (UFBA), BA, Brazil
3 Immunology; Professor, School of Pharmacy, UFBA, BA, Brazil
4 Medicine; Assistant Professor, School of Medicine, UESC, BA, Brazil
5 Medicine; Professor, School of Medicine, UFBA, BA, Brazil
This item has received

Under a Creative Commons license
Article information
Abstract
Objective

To investigate the frequency of thyroid disorders (TD) in patients with chronic hepatitis C before and during interferon-alpha (IFN-α) and ribavirin (RIB) treatment.

Study design

Prospective study.

Patients and Methods

We prospectively studied 65 anti-HCV and viral RNA positive patients. Free thyroxine, thyroid-stimulating hormone, and thyroid peroxidase antibodies (TPO-Ab) were systematically tested at entry (m0), week 12 (m3) and week 24 (m6) of treatment.

Results

Mean age of the 65 patients (38 females and 27 males) was 49.61±11.83 years. Seven (10.76%) patients presented baseline thyroid disorders (m0), three had thyroid dysfunction, and four were TPO-Ab positive. Thyroid disorders occurred in the first 12 weeks of treatment in 11 (16.92%) patients, four with thyroid dysfunction, and seven with TPO-Ab positive (m3). A total of 18 patients (27.69%) developed TD after 24 weeks of treatment, 7 with thyroid dysfunction, and 11 with TPO-Ab positive (m6). The relative risk of developing hypothyroidism found in this study was 1.3 (95% CI: 1.1 to 1.6), hyperthyroidism 1.2 (95% CI: 1.1 to 1.4), and TPO-Ab positivity 7.6 (95% CI: 3.9 to 14.5). The study showed a significant association between female sex and thyroid disease (p=0.009).

Conclusion

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

Keywords:
hepatitis C
interferon-alpha
ribavirin
thyroid diseases
autoimmunity
Full text is only aviable in PDF
References
[1.]
H.A. Tran, G.E. Reeves.
The spectrum of autoimmune thyroid disease in the short to medium term following interferon-alpha therapy for chronic hepatitis C.
Int J Endocrinol, 2009 (2009), pp. 241786
[2.]
Y. Tomer, F. Menconi.
Interferon induced thyroiditis.
Best Pract Res Clin Endocrinol Metab, 23 (2009), pp. 703-712
[3.]
A. Antonelli, C. Ferri, P. Fallahi.
Hepatitis C:thyroid dysfunction in patients with hepatitis C on IFN-alpha therapy.
Nat Rev Gastroenterol Hepatol, 6 (2009), pp. 633-635
[4.]
Y. Tomer, J.T. Blackard, N. Akeno.
Interferon alpha treatment and thyroid dysfunction.
Endocrinol Metab Clin North Am, 36 (2007), pp. 1051-1066
[5.]
N.J. Snell.
Ribavirin - current status of a broad spectrum antiviral agent.
Expert Opin Pharmacother, 2 (2001), pp. 1317-1324
[6.]
R.C. Tam, C. Lim, J. Bard, B. Pai.
Contact hypersensitivity responses following ribavirin treatment in vivo are influenced by type 1 cytokine polarization, regulation of IL-10 expression, and costimulatory signaling.
J Immunol, 163 (1999), pp. 3709-3717
[7.]
L.K. Koh, F.S. Greenspan, P.P. Yeo.
Interferon-alpha induced thyroid dysfunction: three clinical presentations and a review of the literature.
Thyroid, 7 (1997), pp. 891-896
[8.]
H.A. Tran, G.E. Reeves.
The influence of hepatitis C infection and interferon-alpha therapy on thyrotropin blocking and stimulating autoantibodies in Graves ophthalmopathy: a case report.
Thyroid Res, 2 (2009), pp. 12
[9.]
A.L. Zignego, A. Craxì.
Extrahepatic manifestations of hepatitis C virus infection.
Clin. Liver Dis, 12 (2008), pp. 611-636
[10.]
J. Bartolomé, E. Rodríguez-Iñigo, P. Quadros, et al.
Detection of hepatitis C virus in thyroid tissue from patients with chronic HCV infection.
J Med Virol, 80 (2008), pp. 1588-1594
[11.]
P. Simmonds, F. McOmish, P.L. Yap, et al.
Sequence variability in the 5 non-coding region of hepatitis C virus: identification of a new virus type and restrictions on sequence diversity.
J Gen Virol, 74 (1993), pp. 661-668
[12.]
P. Bedossa, T. Poynard.
An algorithm for the grading of activity in chronic hepatitis C. The Metavir Cooperative Study Group.
Hepatology, 24 (1996), pp. 289
[13.]
P. Bedossa.
Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C.
Hepatology, 20 (1994), pp. 15-20
[14.]
H.A. Tran, G.E. Malcolm Reeves, R. Gibson, J.R. Attia.
Development of thyroid diseases in the treatment of chronic hepatitis C with alpha-interferon may be a good prognosticator in achieving a sustained virological response: a meta-analysis.
J Gastroenterol Hepatol, 24 (2009), pp. 1163-1168
[15.]
M.F. Prummel, P. Laurberg.
Interferon-α and Autoimmune Thyroid Disease.
Thyroid, 13 (2003), pp. 547-551
[16.]
E.J. Bini, S. Mehandru.
Incidence of thyroid dysfunction during interferon alfa-2b and ribavirin therapy in men with chronic hepatitis C: a prospective cohort study.
Arch Intern Med, 164 (2004), pp. 2371-2376
[17.]
J.C. Mandac, S. Chaudhry, K.E. Sherman, Y. Tomer.
The clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification.
Hepatology, 43 (2006), pp. 661-672
[18.]
I. Duncea, C.E. Pepene.
IFNalpha-induced recurrence of Graves disease ten years after thyroidectomy in chronic viral hepatitis C. Case report.
J Gastrointestin Liver Dis, 17 (2008), pp. 453-456
[19.]
M.C. Hsieh, M.L. Yu, W.L. Chuang, et al.
Virologic factors related to interferon-alpha-induced thyroid dysfunction in patients with chronic hepatitis C.
Eur J Endocrinol, 142 (2000), pp. 431-437
[20.]
C. Carella, G. Mazziotti, G. Amato, L.E. Braverman, E. Roti.
Clinical review 169: Interferon-alpha-related thyroid disease: pathophysiological, epidemiological, and clinical aspects.
J Clin Endocrinol Metab, 89 (2004), pp. 3656-3661
[21.]
V. Wong, A.X. Fu, J. George, N.W. Cheung.
Thyrotoxicosis induced by alpha-interferon therapy in chronic viral hepatitis.
Clin Endocrinol (Oxf), 56 (2002), pp. 793-798
[22.]
M. Deutsch, S. Dourakis, E.K. Manesis, et al.
Thyroid abnormalities in chronic viral hepatitis and their relationship to interferon alfa therapy.
Hepatology, 26 (1997), pp. 206-210
[23.]
M. Rodríguez-Torres, C.F. Ríos-Bedoya, G. Ortiz-Lasanta, A.M. Marxuach-Cuétara, J. Jiménez-Rivera.
Thyroid dysfunction (TD) among chronic hepatitis C patients with mild and severe hepatic fibrosis.
Ann Hepatol, 7 (2008), pp. 72-77
Copyright © 2011. Elsevier Editora Ltda.. All rights reserved
The Brazilian Journal of Infectious Diseases
Article options
Tools