Thyroid dysfunction in a UK hepatitis C population treated with interferon-α and ribavirin combination therapy

• Published in: Clinical endocrinology (Oxford) Vol. 73; no. 2; pp. 249 - 256
• Main Authors: Costelloe, Seán J., Wassef, Nancy, Schulz, Josephine, Vaghijiani, Tina, Morris, Catherine, Whiting, Stephen, Thomas, Michael, Dusheiko, Geoffrey, Jacobs, Michael, Vanderpump, Mark P. J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2010; Blackwell
• Subjects: Adult; Age of Onset; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Biological and medical sciences; Drug Therapy, Combination - adverse effects; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Human viral diseases; Humans; Infectious diseases; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Retrospective Studies; Ribavirin - administration & dosage; Ribavirin - adverse effects; Thyroid Diseases - chemically induced; Thyroid Diseases - epidemiology; Thyroid. Thyroid axis (diseases); United Kingdom - epidemiology; Vertebrates: endocrinology; Viral diseases; Viral hepatitis; United Kingdom; Europe; Endocrinopathy; Human; Drug combination; Alpha interferon; Thyroid diseases; Hepatic disease; Ribavirin; Infection; Viral hepatitis A; Thyroid function; Viral disease; Nucleoside analog; Digestive diseases; Antiviral; Population; Combined treatment; Endocrinology; Viral hepatitis C
• ISSN: 0300-0664; 1365-2265; 1365-2265
• DOI: 10.1111/j.1365-2265.2010.03785.x

Summary Objective  To assess the incidence of thyroid dysfunction (TD) in a UK cohort of patients with hepatitis C virus (HCV) infection treated with interferon‐α (IFNα) and ribavirin combination therapy (IFN/RBV). Design, patients and measurements  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 ≥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.