title: Incidence of and risk factors for thyroid dysfunction during peginterferon α and ribavirin treatment in patients with chronic hepatitis C.
abstract: OBJECTIVE
  Thyroid dysfunction (TD) is more likely to occur in patients with chronic hepatitis C (CHC) and is particularly associated with interferon (IFN) treatment. The purpose of this study was to investigate the incidence, outcomes, and risk factors for TD during pegylated interferon (PEG-IFN) and ribavirin (RBV) combined therapy in patients with CHC.
  
  
  METHODS
  A total of 242 euthyroid patients with CHC treated with PEG-IFN/RBV were included. Thyroid function and autoantibodies were measured at baseline, and virologic response and thyroid function were assessed every 3 months during therapy.
  
  
  RESULTS
  TD developed in 67 patients (27.7%) during the PEG-IFN/RBV treatment. The types of TD were subclinical hypothyroidism (50.7%), hypothyroidism (14.9%), thyroiditis (11.9%), subclinical hyperthyroidism (10.4%), and hyperthyroidism (10.4%). Most of the patients with TD recovered spontaneously; however, seven patients (10.4%) needed thyroid treatment. The sustained virological response rate was higher in patients with TD than those without (65.7% vs. 49.1%, p = 0.02). Baseline thyroid stimulating hormone (TSH) concentrations (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.96 to 8.77; p < 0.001), presence of the thyroid peroxidase antibody (OR, 8.81; 95% CI, 1.74 to 44.6; p = 0.009), and PEG-IFNα-2b (OR, 3.01; 95% CI, 1.43 to 6.39; p = 0.004) were independent risk factors for the development of TD.
  
  
  CONCLUSIONS
  TD developed in 27.7% of patients with CHC during PEG-IFN/RBV treatment, and 10.4% of these patients needed thyroid treatment. TD is associated with a favorable virologic response to PEG-IFN/RBV. Assessment of TSH and thyroid autoantibodies at baseline and close monitoring of thyroid function during PEG-IFN/RBV therapy are necessary for early detection and management of IFN-induced TD.
authors.affiliation: Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Yong
authors.initials: Y
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.|Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyung Min
authors.initials: HM
authors.lastname: Yu
authors.affiliation: Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Won Hyeok
authors.initials: WH
authors.lastname: Choe
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000009:adverse effects; D056910:Republic of Korea; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects*; D013959:Thyroid Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D013961:Thyroid Gland / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D001323:Autoantibodies; D015415:Biomarkers; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; C006606:anti-thyroglobulin; C056626:thyroid microsomal antibodies; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a
keywords: Hepatitis C, chronic; Incidence; Interferons; Risk factors; Thyroid diseases