Korean J Intern Med.  2015 Nov;30(6):792-800. 10.3904/kjim.2015.30.6.792.

Incidence of and risk factors for thyroid dysfunction during peginterferon alpha and ribavirin treatment in patients with chronic hepatitis C

• Hwang Y
• Kim W
• Kwon SY
• Yu HM
• Kim JH
• Choe WH

• KMID: 2381583
• DOI: http://doi.org/10.3904/kjim.2015.30.6.792

Abstract

BACKGROUND/AIMS
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-IFNalpha-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.

Keyword

Hepatitis C, chronic; Thyroid diseases; Interferons; Incidence; Risk factors

MeSH Terms

Adult
Aged
Antiviral Agents/*adverse effects
Autoantibodies/blood
Biomarkers/blood
Drug Therapy, Combination
Female
Hepatitis C, Chronic/diagnosis/*drug therapy
Humans
Incidence
Interferon-alpha/*adverse effects
Male
Middle Aged
Polyethylene Glycols/*adverse effects
Recombinant Proteins/adverse effects
Republic of Korea
Retrospective Studies
Ribavirin/*adverse effects
Thyroid Diseases/*chemically induced/diagnosis/epidemiology/immunology/physiopathology
Thyroid Gland/*drug effects/immunology/physiopathology
Time Factors
Treatment Outcome
Antiviral Agents
Autoantibodies
Biomarkers
Interferon-alpha
Polyethylene Glycols
Recombinant Proteins
Ribavirin