Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
Centre of Liver Diseases, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, 09042, Monserrato, Cagliari, Italy.
J Endocrinol Invest. 2023 Feb;46(2):359-366. doi: 10.1007/s40618-022-01909-0. Epub 2022 Sep 1.
It is well known that interferon-α (IFN-α), used for long time as the main therapy for HCV-related disease, induces thyroid alterations, but the impact of the new direct-acting antivirals (DAAs) on thyroid is not established. Aim of this prospective study was to evaluate if DAAs therapy may induce thyroid alterations.
A total of 113 HCV patients, subdivided at the time of the enrollment in naïve group (n = 64) and in IFN-α group (n = 49) previously treated with pegylated interferon-α and ribavirin, were evaluated for thyroid function and autoimmunity before and after 20-32 weeks of DAAs.
Before starting DAAs, a total of 8/113 (7.1%) patients showed Hashimoto's thyroiditis (HT) all belonging to IFN-α group (8/49, 16.3%), while no HT cases were found in the naïve group. Overall, 7/113 (6.2%) patients were hypothyroid: 3/64 (4.7%) belonging to naïve group and 4/49 (8.2%) to IFN-α group. Furthermore, a total of 8/113 patients (7.1%) showed subclinical hyperthyroidism: 2/64 (3.1%) were from naïve group and 6/49 (12.2%) from IFN-α group. Interestingly, after DAAs therapy, no new cases of HT, hypothyroidism and hyperthyroidism was found in all series, while 6/11 (54.5%) patients with non-autoimmune subclinical thyroid dysfunction became euthyroid. Finally, the only association between viral genotypes and thyroid alterations was genotype 1 and hypothyroidism.
This study supports evidence that DAAs have a limited or missing influence on thyroid in patients with HCV-related diseases. Moreover, it provides preliminary evidence that subclinical non-autoimmune thyroid dysfunction may improve after HCV infection resolution obtained by DAAs.
干扰素-α（IFN-α）长期以来一直是治疗丙型肝炎相关疾病的主要药物，已知其可引起甲状腺改变，但新的直接作用抗病毒药物（DAAs）对甲状腺的影响尚未确定。本前瞻性研究旨在评估 DAAs 治疗是否会引起甲状腺改变。
共纳入 113 例 HCV 患者，根据入组时是否为初治组（n=64）和 IFN-α组（n=49）进行分组，前者未接受过聚乙二醇干扰素-α和利巴韦林治疗，后者曾接受过该方案治疗。所有患者在开始 DAAs 治疗前及 20-32 周后均检测甲状腺功能和自身免疫情况。
在开始 DAAs 治疗前，共有 8/113（7.1%）例患者存在桥本甲状腺炎（HT），均为 IFN-α组患者（8/49，16.3%），而初治组未发现 HT 患者。总体而言，7/113（6.2%）例患者为甲状腺功能减退症：3/64（4.7%）例来自初治组，4/49（8.2%）例来自 IFN-α组。此外，共有 8/113 例患者（7.1%）表现为亚临床甲状腺功能亢进症：2/64（3.1%）例来自初治组，6/49（12.2%）例来自 IFN-α组。有趣的是，在 DAAs 治疗后，所有患者均未出现新的 HT、甲状腺功能减退症和甲状腺功能亢进症，而非自身免疫性亚临床甲状腺功能障碍的 6/11（54.5%）例患者恢复为甲状腺功能正常。最后，病毒基因型与甲状腺改变之间唯一的关联是基因型 1 和甲状腺功能减退症。
本研究支持 DAAs 对丙型肝炎相关疾病患者甲状腺影响有限或不存在的证据。此外，本研究初步证明，DAAs 可清除 HCV 感染，非自身免疫性亚临床甲状腺功能障碍可能改善。
