Unidade de Tireóide, Laboratório de Endocrinologia Celular e Molecular, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2011;66(10):1757-63. doi: 10.1590/s1807-59322011001000014.
To characterize thyroid disturbances induced by interferon-alpha and ribavirin therapy in patients with chronic hepatitis C.
Interferon-alpha is used to treat chronic hepatitis C infections. This compound commonly induces both autoimmune and non-autoimmune thyroiditis.
We prospectively selected 26 patients with chronic hepatitis C infections. Clinical examinations, hormonal evaluations, and color-flow Doppler ultrasonography of the thyroid were performed before and during antiviral therapy.
Of the patients in our study, 54% had no thyroid disorders associated with the interferon-alpha therapy but showed reduced levels of total T3 along with a decrease in serum alanine aminotransferase. Total T4 levels were also reduced at 3 and 12 months, but free T4 and thyroid stimulating hormone (TSH) levels remained stable. A total of 19% of the subjects had autoimmune interferon-induced thyroiditis, which is characterized by an emerge of antithyroid antibodies or overt hypothyroidism. Additionally, 16% had non-autoimmune thyroiditis, which presents as destructive thyroiditis or subclinical hypothyroidism, and 11% remained in a state of euthyroidism despite the prior existence of antithyroidal antibodies. Thyrotoxicosis with destructive thyroiditis was diagnosed within three months of therapy, and ultrasonography of these patients revealed thyroid shrinkage and discordant change in the vascular patterns.
Decreases in the total T3 and total T4 levels may be related to improvements in the hepatocellular lesions or inflammatory changes similar to those associated with nonthyroidal illnesses. The immune mechanisms and direct effects of interferon-alpha can be associated with thyroiditis.
Interferon-alpha and ribavirin induce autoimmune and non-autoimmune thyroiditis and hormonal changes (such as decreased total T3 and total T4 levels), which occur despite stable free T4 and TSH levels. A thyroid hormonal evaluation, including the analysis of the free T4, TSH, and antithyroid antibody levels, should be mandatory before therapy, and an early re-evaluation within three months of treatment is necessary as an appropriate follow-up.
描述慢性丙型肝炎患者接受干扰素-α和利巴韦林治疗后发生的甲状腺功能紊乱。
干扰素-α用于治疗慢性丙型肝炎感染。该药物通常会引起自身免疫性和非自身免疫性甲状腺炎。
我们前瞻性地选择了 26 例慢性丙型肝炎感染患者。在抗病毒治疗前和治疗期间进行了临床检查、激素评估和甲状腺彩色多普勒超声检查。
在我们的研究中，54%的患者没有与干扰素-α治疗相关的甲状腺疾病，但总 T3 水平降低，同时血清丙氨酸氨基转移酶下降。总 T4 水平在 3 个月和 12 个月时也降低，但游离 T4 和促甲状腺激素（TSH）水平保持稳定。共有 19%的患者出现自身免疫性干扰素诱导的甲状腺炎，其特征是出现抗甲状腺抗体或明显的甲状腺功能减退。此外，16%的患者患有非自身免疫性甲状腺炎，表现为破坏性甲状腺炎或亚临床甲状腺功能减退，11%的患者尽管存在抗甲状腺抗体，但仍处于甲状腺功能正常状态。甲状腺功能亢进伴破坏性甲状腺炎在治疗后 3 个月内被诊断出来，这些患者的超声显示甲状腺缩小和血管模式的不一致变化。
总 T3 和总 T4 水平的降低可能与肝细胞病变或炎症变化的改善有关，类似于非甲状腺疾病相关的变化。干扰素-α的免疫机制和直接作用可能与甲状腺炎有关。
干扰素-α和利巴韦林可诱导自身免疫性和非自身免疫性甲状腺炎以及激素变化（如总 T3 和总 T4 水平降低），尽管游离 T4 和 TSH 水平稳定。治疗前应强制性进行甲状腺激素评估，包括游离 T4、TSH 和抗甲状腺抗体水平的分析，并在治疗后 3 个月内进行早期重新评估作为适当的随访。
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