Increased risk of autoimmune thyroid disease in hepatitis C vs hepatitis B before, during, and after discontinuing interferon therapy.
BACKGROUND
Thyroid gland dysfunction has been reported to occur with variable frequency during interferon alfa (IFN-alpha) therapy in patients with the hepatitis C virus (HCV). We prospectively evaluated if the prevalence of autoimmune thyroid disease in patients with HCV differs from that in patients with the hepatitis B virus (HBV) before, at the end of, and 6 months after stopping treatment with IFN-alpha.


METHODS
One hundred thirty-four patients with HCV and 41 patients with HBV were studied. Measurements of serum free thyroxine, free triiodothyronine, thyrotropin, thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), and thyrotropin-binding inhibitory immunoglobulin were performed.


RESULTS
Positive levels of TPOAb and TgAb were found in 20% and 11% of patients with HCV compared with 5% and 3% of patients with HBV, respectively. At the end of IFN-alpha therapy, thyroid gland dysfunction was more prevalent in patients with HCV (12%) compared with those with HBV (3%), with thyrotropin levels significantly higher in the HCV group (P = .03). Titers of TPOAb, TgAb, and thyrotropin-binding inhibitory immunoglobulin increased significantly (P = .02, P = .04, and P = .02, respectively) at the end of IFN-alpha therapy in patients with HCV but not in those with HBV. Patients who developed thyroid gland dysfunction were predominantly female (P = .03), had decreased levels of free triiodothyronine (P<.001), and had a higher prevalence of TPOAb (P = .03) before treatment with IFN-alpha. Thyroid gland dysfunction was reversed in 60% of those with HCV 6 months after discontinuing treatment with IFN-alpha.


CONCLUSIONS
Patients with HCV are more susceptible than patients with HBV to autoimmune thyroid disease. Systematic screening of thyroid gland function and TPOAb titers in all patients with HCV before, during, and after IFN-alpha therapy appears warranted. This precaution is not necessary for patients with HBV.
Endocrine and Metabolic Unit, Universitary Hospital, Granada, Spain.
L
L
Fernandez-Soto
A
A
Gonzalez
F
F
Escobar-Jimenez
R
R
Vazquez
E
E
Ocete
N
N
Olea
J
J
Salmeron
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D016898:Interferon-alpha / Q000627:therapeutic use*; D007453:Iodide Peroxidase / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011989:Receptors, Thyrotropin / Q000097:blood; D012306:Risk; D013954:Thyroglobulin / Q000276:immunology; D013963:Thyroid Hormones / Q000097:blood; D013967:Thyroiditis, Autoimmune / Q000097:blood / Q000209:etiology* / Q000276:immunology / Q000821:virology
D000998:Antiviral Agents; D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D016898:Interferon-alpha; D011989:Receptors, Thyrotropin; D013963:Thyroid Hormones; C094372:thyrotropin-binding inhibitory immunoglobulin; D013954:Thyroglobulin; D007453:Iodide Peroxidase