Is steroid therapy needed in the treatment of destructive thyrotoxicosis induced by alpha-interferon in chronic hepatitis C?
OBJECTIVE
Treatment with interferon (IFN) of patients affected by chronic hepatitis C (CH-C) may produce alterations in thyroid function, such as hypothyroidism, Graves'-like hyperthyroidism and destructive thyrotoxicosis (DT). IFN-induced DT is characterized by suppressed serum TSH levels, normal or elevated FT4 and FT3 concentrations, with the presence or absence of thyroid peroxidase antibodies and antithyroglobulin antibodies, the absence of thyroid receptor antibodies and radioactive iodine uptake suppressed or <5%.


METHODS
IFN-induced DT is a mild clinical disease, because thyroid-destructive processes last for a short time and involve a small portion of the gland. At present, the therapeutic approach in DT suggests IFN withdrawal and 1-2 months of methylprednisolone treatment.


METHODS
In consideration of possible untoward side effects of steroid treatment in patients with CH-C, we studied two groups of patients with CH-C who developed DT after treatments with various preparations of recombinant IFN (with or without ribavirin). Patients sequentially entered the study during a 4-year period, at the time of DT diagnosis, when IFN therapy was discontinued. The first 12 subjects (group A) were treated with 8-16 mg/day methylprednisolone for 30-40 days after IFN withdrawal; in the following 15 patients (group B), IFN withdrawal was not followed by any additional treatment. All patients underwent clinical and laboratory controls of thyroid function at 1, 2, 3 and 6 months after DT diagnosis.


RESULTS
The results showed restoration of euthyroidism in both group A and group B patients at 6 months after DT diagnosis, regardless of steroid treatment.


CONCLUSIONS
The simple withdrawal of IFN therapy in patients with CH-C, who had developed DT, appears to be effective in the treatment of the thyroid disease. This therapeutic approach should be preferred in order to avoid possible undesired side effects of steroid therapy in patients with CH-C.
Minelli
Roberta
R
Università di Parma, Italia. roberta.minelli@unipr.it
Valli
Maria Antonietta
MA
Di Seclì
Clelia
C
Finardi
Lorenzo
L
Chiodera
Paolo
P
Bertoni
Roberto
R
Ferrari
Carlo
C
Barilli
Angela Luciana
AL
Coiro
Vittorio
V
Saccani Jotti
Gloria
G
Delsignore
Roberto
R
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D007370:Interferon Type I / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011994:Recombinant Proteins; D013960:Thyroid Function Tests; D013971:Thyrotoxicosis / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D007370:Interferon Type I; D011994:Recombinant Proteins; D014284:Triiodothyronine; D013974:Thyroxine; D008775:Methylprednisolone