Division of Endocrinology, Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
J Endocrinol Invest. 2011 Jan;34(1):78-84. doi: 10.1007/BF03346699. Epub 2010 Feb 28.
Autoimmune thyroid diseases (AITD) are postulated to develop as a result of a complex interplay between several genetic and environmental influences. The pathogenesis of AITD is still not clearly defined. However, among the implicated triggers (e.g. iodine, infections, medications), more recent data confirmed strong associations of AITD with the hepatitis C virus (HCV) infection and interferon-α (IFNα) therapy. Moreover, it is likely that HCV and IFN act in synergism to trigger AITD in patients. Indeed, approximately 40% of HCV patients develop either clinical or subclinical disease while receiving IFNα. Interferon induced thyroiditis (IIT) can manifest as non-autoimmune thyroiditis (presenting as destructive thyroiditis, or non-autoimmune hypothyroidism), or autoimmune thyroiditis [presenting with clinical features of Graves' disease (GD) or Hashimoto's thyroiditis (HT)]. Although not yet clearly understood, it is thought that IFNα can induce thyroiditis via both immune stimulatory and direct toxic effects on the thyroid. In view of the high frequency of IIT, routine screening and surveillance of HCV patients receiving IFNα is recommended to avoid the complications, such as cardiac arrhythmias, associated with thyrotoxicosis. In summary, IIT is a common clinical problem that can be readily diagnosed with routine thyroid function screening of HCV patients receiving IFN. The treatment of IIT consists of the standard therapy for differing clinical manifestations of IIT such as GD, HT, or destructive thyroiditis. However, anti-thyroid medications are not recommended in this setting since they can potentially be hepatotoxic.
自身免疫性甲状腺疾病（AITD）被认为是多种遗传和环境因素相互作用的结果。AITD 的发病机制尚不清楚。然而，在所涉及的触发因素（例如碘、感染、药物）中，最近的数据证实 AITD 与丙型肝炎病毒（HCV）感染和干扰素-α（IFNα）治疗有很强的关联。此外，HCV 和 IFN 可能协同作用，在患者中引发 AITD。事实上，大约 40%的 HCV 患者在接受 IFNα 治疗时会出现临床或亚临床疾病。干扰素诱导的甲状腺炎（IIT）可表现为非自身免疫性甲状腺炎（表现为破坏性甲状腺炎或非自身免疫性甲状腺功能减退症），或自身免疫性甲状腺炎[表现为 Graves 病（GD）或桥本甲状腺炎（HT）的临床特征]。虽然尚不清楚，但人们认为 IFNα 可以通过对甲状腺的免疫刺激和直接毒性作用来诱导甲状腺炎。鉴于 IIT 的高频率，建议对接受 IFNα 治疗的 HCV 患者进行常规筛查和监测，以避免与甲状腺毒症相关的心律失常等并发症。总之，IIT 是一个常见的临床问题，可以通过对接受 IFN 的 HCV 患者进行常规甲状腺功能筛查来诊断。IIT 的治疗包括针对 GD、HT 或破坏性甲状腺炎等不同临床表现的标准治疗。然而，在这种情况下不建议使用抗甲状腺药物，因为它们可能具有肝毒性。
