Patterns of Interferon-Alpha–Induced Thyroid Dysfunction Vary with Ethnicity, Sex, Smoking Status, and Pretreatment Thyrotropin in an International Cohort of Patients Treated for Hepatitis C

Mammen, Jennifer S.; Ghazarian, Sharon R.; Rosen, Antony; Ladenson, Paul W.

doi:10.1089/thy.2012.0565

Cited by 11 publications

(7 citation statements)

References 38 publications

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“…This finding could be related to the clinical heterogeneity and to assays and thresholds used that likely contribute to the statistical heterogeneity observed in our study population with the respect to other studies. 26 Moreover, since female sex as well as Caucasic ethnicity represent risk factors for TAI, 40 the relatively high prevalence of TAI in our controls is conceivable. We included in the TAI group women with both normal and impaired thyroid function in accordance with the idea that the presence of anti-thyroid autoantibodies could represent the main factor leading to an increased risk of reproductive failure even in the absence of clinically overt hypothyroidism.…”

Section: Discussionmentioning

confidence: 95%

Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure

Triggianese

Perricone

Conigliaro

et al. 2015

Int J Immunopathol Pharmacol

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Abnormalities in peripheral blood natural killer (NK) cells have been reported in women with primary infertility and recurrent spontaneous abortion (RSA) and several studies have been presented to define cutoff values for abnormal peripheral blood NK cell levels in this context. Elevated levels of NK cells were observed in infertile/RSA women in the presence of thyroid autoimmunity (TAI), while no studies have been carried out, to date, on NK cells in infertile/ RSA women with non-autoimmune thyroid diseases. The contribution of this study is two-fold: (1) the evaluation of peripheral blood NK cell levels in a cohort of infertile/RSA women, in order to confirm related data from the literature; and (2) the assessment of NK cell levels in the presence of both TAI and subclinical hypothyroidism (SCH) in order to explore the possibility that the association between NK cells and thyroid function is not only restricted to TAI but also to SCH. In a retrospective study, 259 age-matched women (primary infertility [n = 49], primary RSA [n = 145], and secondary RSA [n = 65]) were evaluated for CD56+CD16+NK cells by flow cytometry. Women were stratified according to thyroid status: TAI, SCH, and without thyroid diseases (ET). Fertile women (n = 45) were used as controls. Infertile/RSA women showed higher mean NK cell levels than controls. The cutoff value determining the abnormal NK cell levels resulted ⩾15% in all the groups of women. Among the infertile/RSA women, SCH resulted the most frequently associated thyroid disorder while no difference resulted in the prevalence of TAI and ET women between patients and controls. A higher prevalence of women with NK cell levels ⩾15% was observed in infertile/RSA women with SCH when compared to TAI/ET women. According to our data, NK cell assessment could be used as a diagnostic tool in women with reproductive failure and we suggest that the possible association between NK cell levels and thyroid function can be described not only in the presence of TAI but also in the presence of non-autoimmune thyroid disorders.

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Section: Discussionmentioning

confidence: 95%

Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure

Triggianese

Perricone

Conigliaro

et al. 2015

Int J Immunopathol Pharmacol

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“…Risk factors associated with AITD in the setting of IFN- α treatment for HCV include female gender (RR 4.4) as well as the presence of anti-TPO antibodies prior to therapy (RR 3.9); however treatment with IFN- α itself has been associated with the de novo development of anti-TPO antibodies [ 6 ]. Being female and having a higher pretreatment TSH were strongly associated with biphasic thyroiditis, whereas Asian ethnicity and being a current smoker decreased the risk [ 7 ]. Arguably, pretreatment thyroid function may be used to predict those who develop AITD but is undoubtedly indicated in all patients about to commence IFN- α therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Incidence of hyperthyroidism varies among studies as well, with approximately 25% to 60% suffering from transient thyrotoxicosis and the remainder having scintigraphic and/or biochemical evidence of Graves' Hyperthyroidism, many of which required treatment [ 6 ]. In contrast, a large study of 869 HCV patients receiving IFN- α reported biphasic thyroiditis responsible for the majority of AITD cases (58%) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Hashimoto’s Thyroiditis and Graves’ Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment

Bishay

Chen

2016

Case Reports in Endocrinology

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Autoimmune thyroid disease associated with interferon therapy can manifest as destructive thyroiditis, Graves' Hyperthyroidism, and autoimmune (often subclinical) hypothyroidism, the latter persisting in many patients. There are scare reports of a single patient developing extremes of autoimmune thyroid disease activated by the immunomodulatory effects of interferon. A 60-year-old man received 48 weeks of pegylated interferon and ribavirin therapy for chronic HCV. Six months into treatment, he reported fatigue, weight gain, and slowed cognition. Serum thyroid stimulating hormone (TSH) was 58.8 mIU/L [0.27–4.2], fT4 11.1 pmol/L [12–25], and fT3 4.2 pmol/L [2.5–6.0] with elevated anti-TPO (983 IU/mL [<35]) and anti-TG (733 U/mL [<80]) antibodies. He commenced thyroxine with initial clinical and biochemical resolution but developed symptoms of hyperthyroidism with weight loss and tremor 14 months later. Serum TSH was <0.02 mIU/L, fT4 54.3 pmol/L, and fT3 20.2 pmol/L, with an elevated TSH receptor (TRAb, 4.0 U/L [<1.0]), anti-TPO (1,163 IU/mL) and anti-TG (114 U/mL) antibodies. Technetium scan confirmed Graves' Disease with bilateral diffuse increased tracer uptake (5.9% [0.5–3.5%]). The patient commenced carbimazole therapy for 6 months. Treatment was ceased following spontaneous clinical and biochemical remission (TSH 3.84 mIU/L, fT4 17pmol/L, fT3 4.5 pmol/L, and TRAb <1 U/L). This raises the need to monitor thyroid function closely in patients both during and following completion of interferon treatment.

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“…Furthermore, Prummel and Laurberg showed that positive pretreatment AbTPOs are an important risk factor for the development of thyroid dysfunction [74]. There is also an obvious link between female sex, old age, and genetic predisposition with the development of antibodies [75,76].…”

Section: Chc Infection and Thyroid Autoimmunitymentioning

confidence: 99%

Autoimmune and Neoplastic Thyroid Diseases Associated with Hepatitis C Chronic Infection

Fallahi

Ferrari

Politti

et al. 2014

International Journal of Endocrinology

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Frequently, patients with hepatitis C virus (HCV) chronic infection have high levels of serum anti-thyroperoxidase and/or anti-thyroglobulin autoantibodies, ultrasonographic signs of chronic autoimmune thyroiditis, and subclinical hypothyroidism, in female gender versus healthy controls, or hepatitis B virus infected patients. In patients with “HCV-associated mixed cryoglobulinemia” (MC + HCV), a higher prevalence of thyroid autoimmune disorders was shown not only compared to controls, but also versus HCV patients without cryoglobulinemia. Patients with MC + HCV or HCV chronic infection show a higher prevalence of papillary thyroid cancer than controls, in particular in patients with autoimmune thyroiditis. Patients with HCV chronic infection, or with MC + HCV, in presence of autoimmune thyroiditis, show higher serum levels of T-helper (Th)1 (C-X-C motif) ligand 10 (CXCL10) chemokine, but normal levels of Th2 (C-C motif) ligand 2 chemokine, than patients without thyroiditis. HCV thyroid infection could act by upregulating CXCL10 gene expression and secretion in thyrocytes recruiting Th1 lymphocytes that secrete interferon-γ and tumor necrosis factor-α. These cytokines might induce a further CXCL10 secretion by thyrocytes, thus perpetuating the immune cascade, which may lead to the appearance of autoimmune thyroid disorders in genetically predisposed subjects. A careful monitoring of thyroid function, particularly where nodules occur, is recommended in HCV patients.

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Patterns of Interferon-Alpha–Induced Thyroid Dysfunction Vary with Ethnicity, Sex, Smoking Status, and Pretreatment Thyrotropin in an International Cohort of Patients Treated for Hepatitis C

Cited by 11 publications

References 38 publications

Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure

Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure

Hashimoto’s Thyroiditis and Graves’ Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment

Autoimmune and Neoplastic Thyroid Diseases Associated with Hepatitis C Chronic Infection

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