Interferon-alpha-induced hyperthyroidism: a three-stage evolution from silent thyroiditis towards Graves' disease.
Autoimmune thyroid disease is a common side-effect of interferon-alpha (IFN-alpha) treatment of viral hepatitis C. We have described three patients with hepatitis C for whom IFN-alpha and ribavirin were prescribed and who developed two successive phases of silent thyroiditis followed by hyperthryroidism relapse due to Graves' disease. These three men had no known history of familial or personal thyroid disease. Destructive thyrotoxicosis appeared 4-6 months after starting IFN-alpha, followed by Graves' hyperthyroidism within 8 to 11 months. The thyrotropin (TSH) level was normal before IFN-alpha was started. The diagnosis of destructive thyroiditis was confirmed by anti-TSH receptor antibody (TSHRAb) negativity and the absence of radionuclide ((123)I or (99)Tc) uptake on thyroid scintiscans. Eight to eleven months after starting treatment, TSHRAb positivity and intense scintigraphic uptake confirmed the appearance of Graves' disease. IFN-alpha was continued in only one patient. Hence, hyperthyroidism induced by IFN-alpha could correspond to the first phase of silent thyroiditis, to Graves' disease or to the succession of both. Rigorous diagnostic procedures with repeated scintiscans and TSHRAb titering are necessary to avoid a false diagnosis and inappropriate therapy.
Service d'Endocrinologie, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, France.
Nathalie Lévy
NL
Bohbot
Jacques
J
Young
Jacques
J
Orgiazzi
Catherine
C
Buffet
Maud
M
François
Brigitte
B
Bernard-Chabert
Céline
C
Lukas-Croisier
Brigitte
B
Delemer
D000328:Adult; D006111:Graves Disease / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006980:Hyperthyroidism / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D007370:Interferon Type I / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011877:Radionuclide Imaging; D011994:Recombinant Proteins; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood; D013966:Thyroiditis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology
D007370:Interferon Type I; D011994:Recombinant Proteins; D013963:Thyroid Hormones