Thyroid dysfunction in a UK hepatitis C population treated with interferon-alpha and ribavirin combination therapy.
OBJECTIVE
To assess the incidence of thyroid dysfunction (TD) in a UK cohort of patients with hepatitis C virus (HCV) infection treated with interferon-alpha (IFNalpha) and ribavirin combination therapy (IFN/RBV).


METHODS
A retrospective study of 288 patients who received IFN/RBV for HCV during a 2-year period from January 2006 was performed. Thyroid function was assessed during a 24-week or 48-week course of IFN/RBV. If serum thyrotrophin (TSH) became undetectable (<0.01 mU/l) and serum free thyroxine (T4) was raised, a diagnostic thyroid isotope scan was performed.


RESULTS
Full medical records were examined for 260 patients (172 men, 88 women) included in the study, of whom 22.3% (16.9% of men, 33.0% of women) developed TD during IFN/RBV. In total, 10.4% developed a suppressed serum TSH (0.8% Graves' disease, 9.6% transient thyroiditis) while 11.9% developed an elevated serum TSH with 1.5% becoming permanently hypothyroid and requiring levothyroxine therapy. Women had a relative risk (RR) for developing TD of 1.96 (CI: 1.75-3.03, P = 0.004). A serum TSH > or =1.75 mU/l and a positive thyroid peroxidase (TPO) antibody titre pretherapy were associated with RRs for progression to TD of 6.02 (CI: 2.95-12.78, P < 0.0001) and 4.35 (CI: 2.58-6.52; P < 0.0001), respectively, while combination of baseline TSH and TPO antibody data predicted progression to TD with a sensitivity of 94.7%.


CONCLUSIONS
Although TD was common in this cohort, just 2.3% developed TD that required ongoing therapy. Pre-IFN/RBV serum TSH and TPO antibody titre were found to predict progression to TD in this group of patients.
Department of Clinical Biochemistry, The Royal Free Hampstead NHS Trust, Pond Street, London, United Kingdom.
Seán J
SJ
Costelloe
Nancy
N
Wassef
Josephine
J
Schulz
Tina
T
Vaghijiani
Catherine
C
Morris
Stephen
S
Whiting
Michael
M
Thomas
Geoffrey
G
Dusheiko
Michael
M
Jacobs
Mark P J
MP
Vanderpump
D000328:Adult; D017668:Age of Onset; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D013959:Thyroid Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin