Thyroid Dysfunction in Chinese Patients with Chronic Hepatitis C Treated with Interferon Alpha: Incidence, Long-Term Outcome and Predictive Factors

Abstract

BackgroundThyroid dysfunction (TD) represents an extra-hepatic manifestation of chronic hepatitis C (CHC) and it may also be a side effect of interferon-alpha (IFN-α) based treatment. However, previous studies have shown a wide variation in the incidence of TD in patients with CHC. Furthermore, the long-term outcomes and the predictive factors of TD in patients who receive IFN-α based treatment have still not been fully studied.ObjectivesThe purpose of this study was to describe the incidence and long-term outcomes of TD in Chinese patients with CHC receiving IFN-αbased treatment. We also aimed to identify the predictive factors of TD associated with this type of therapy.Patients and MethodsA retrospective case-series study of 592 consecutive CHC patients with normal baseline thyroid functions, who received IFN-αbased therapy, was performed. Thyroid function was assessed at baseline and every three months during treatment, as well as in the follow-up after cessation of therapy. The incidence and long-term outcomes of TD were observed. The prevalence of pretreatment thyroid peroxidase antibodies (TPOAb) were assayed in a sex- and age-matched nested case-control study. Multivariable stepwise regression analysis was used to explore the independent effects of the baseline factors, on the incidence of TD.ResultsAt the end of the IFN-αbased therapy, 68 patients (11.5%) in the study had developed TD, 58 patients (85.3%) presented with subclinical TD, and only 10 patients (14.7%) developed overt thyroiditis. The thyroid function of 46 patients (67.8%) spontaneously returned to normal in the six months of follow-up and only three patients (4.4%) had persistent overt TD symptoms after the 24 month follow-up period. Multivariate stepwise analysis suggested that gender and pretreatment TPOAb were the independent factors related to the incidence of TD. Both female patients (OR, 4.31; 95%CI, 2.06–7.31; P = 1.26×10-4) and participants with a positive pretreatment TPOAb (OR = 3.9, 95%CI, 1.72–8.54, P = 0.008) had an increased risk for the development of TD.ConclusionsThe incidence of TD in Chinese patients with CHC during IFN-αbased therapy was 11.5%, the majority of which was subclinical, while only a very small group had long-term overt TD requiring ongoing medical therapy. Female gender and pretreatment TPOAb positivity are risk factors for the development of TD during IFN-αbased therapy.

Prevalence of thyroid disorders and the correlation of thyroid profile with liver enzymes, serum activin-A and follistatin during the treatment of patients with chronic hepatitis C genotype 1 and 4

“…Females are at higher risk of developing thyroiditis following CHC and peg-INF-α [3]. Furthermore, hypothyroidism has also been reported to be more common than hyperthyroidism [26,27]. Similar results were also reported form the UK [28], Taiwan [29] and Australia [30].…”

“…This variability can also be attributed to the diverse genetic predisposition of the subjects [27,33]. However, the detected significant difference in the prevalence of TSHR-Abs in our study suggests that the development of antibodies against TSH receptor are common in Saudi patients during CHC and during the treatment with Peg-INF-α based therapy.…”

“…Our results correlate with the previous studies as we have detected Tabs in 60% of our patients. However, the higher prevalence in our study could be due to differences in the study design and the sample size, which is smaller in our study, or different environmental and genetic predispositions [27].…”

Frequency of Hypothyroidism in Patients with Hepatitis C on Standard Interferon Therapy

“…Nadeem et al, conducted a study in 2010 and suggested to reduce the dose of IFN therapy if any thyroid dysfunction develops [10]. Yan et al, studied the potential impact of thyroid dysfunction due to interferon therapy and reported that 11.5% patients had thyroid dysfunction, out of which 6.4% patients had hypothyroidism on IFN therapy [11].…”

Some Considerations About Cardiac Toxicity of Combination Therapy for Chronic Hepatitis C

“…7) These medications can effect on other organs and tissue such as thyroid gland, blood pressure and etc which can influence cardiovascular health (13, 15). Therefore, we cannot carefully conclude about the safety of these drugs on heart while we did not consider their effects on other organs.…”