Savvas Savvas P, Papakostas Nikolaos, Giannaris Markos, Malaktari Sophia, Koskinas John, Archimandritis Athanasios J
2nd Department of Medicine, Medical School of Athens, Hippokration General Hospital, Athens, Greece.
South Med J. 2010 Jun;103(6):585-8. doi: 10.1097/SMJ.0b013e3181ddd952.
The case of a 37-year-old man with chronic hepatitis C virus (HCV) infection is presented. The patient had received a 6-month course of antiviral therapy with peg interferon alpha-2a and ribavirin, with concomitant clearance of hepatitis C virus ribonucleic acid (HCV-RNA) from serum at the end of treatment. Three months after the treatment course he developed clinical and laboratory features of hypothyroidism along with high titers of thyroid peroxidase antibodies. Later on, while on treatment with levothyroxine, he developed all the clinical features of Graves disease along with increased levels of thyroid stimulating hormone (TSH)-receptor antibodies.This patient exhibited a rare sequence of immune-mediated thyroid disorders as a result of interferon alpha treatment. At the end of treatment, the patient developed Hashimoto thyroiditis, a typically Th1-response-mediated disease, followed sequentially after 6 months by Graves disease, a typically Th2-response-mediated disorder. Although both clinical entities have been described in patients receiving interferon-based regimens, to our knowledge, the changing pattern of immune-mediated thyroid disease in the same individual has not been reported in the literature.
本文介绍了一名37岁慢性丙型肝炎病毒（HCV）感染男性患者的病例。该患者接受了为期6个月的聚乙二醇化干扰素α-2a和利巴韦林抗病毒治疗，治疗结束时血清丙型肝炎病毒核糖核酸（HCV-RNA）随之清除。治疗疗程结束3个月后，他出现了甲状腺功能减退的临床和实验室特征，同时甲状腺过氧化物酶抗体滴度很高。后来，在接受左甲状腺素治疗时，他出现了格雷夫斯病的所有临床特征，同时促甲状腺激素（TSH）受体抗体水平升高。该患者因干扰素α治疗出现了罕见的免疫介导性甲状腺疾病序列。治疗结束时，患者患上了桥本甲状腺炎，这是一种典型的由Th1反应介导的疾病，6个月后依次患上了格雷夫斯病，这是一种典型的由Th2反应介导的疾病。尽管在接受基于干扰素的治疗方案的患者中都曾描述过这两种临床病症，但据我们所知，同一患者免疫介导性甲状腺疾病的变化模式在文献中尚未见报道。
