Custro N, Montalto G, Scafidi V, Soresi M, Gallo S, Tripi S, Notarbartolo A
Istituto di Medicina Interna e Geriatria, University of Palermo, Italy.
J Endocrinol Invest. 1997 Jul-Aug;20(7):374-80. doi: 10.1007/BF03347987.
This study was designed to assess patients with chronic hepatitis C (CHC) for the presence of thyroid autoimmunity and dysfunction, to evaluate the risk of thyroid disorders associated with interferon (IFN) therapy, and to survey the outcome of possible treatment-related thyroid injury. Out of 104 consecutive untreated patients (30 women and 74 men; mean age, 52.7 years), 8 (7.7%) were found seropositive for thyroid autoantibodies (ThyAb), whereas seropositivity in healthy controls was 1/98 (1.3%). The relative increase in risk of developing thyroid autoimmunity associated with CHC was 760% (95% CI, 220-1300%). No patients had abnormalities of thyroid function tests, but on IFN treatment, 3/3 patients showed a rapid over-range rise in circulating thyrotropin, which returned to normal after therapy discontinuation. In the other 5 seropositive patients who refused treatment, thyroid function remained normal. Out of the 58 initially seronegative patients who consented to IFN treatment, 9 (15.5%) developed thyroid autoimmunity. Seven of them (77.7%) had thyroid dysfunction: hypothyroidism in 4 cases, transient thyrotoxicosis in 2 cases. The last patient developed TSH-receptor antibodies and Graves' disease, requiring methimazole therapy. Thyroid function recovered in the former 6 cases following IFN discontinuation. In the 28 initially seronegative patients who refused IFN and participated in a preliminary tauroursodeoxycholic acid trial, antithyroglobulin antibodies alone appeared in one case, but no thyroid dysfunction was observed. The relative risk of thyroid autoimmune disorder associated with IFN therapy was 342% (28-636%). The patients with CHC were unlikely to develop thyroid dysfunction in the absence of IFN therapy, in spite of being ThyAb seropositive. Moreover, a considerable proportion of seronegative patients, when IFN-treated, developed thyroid autoimmunity and then thyroid dysfunction. Both in seropositive and seronegative patients immediate IFN discontinuation normalized thyroid function and hormone replacement therapy was not necessary.
本研究旨在评估慢性丙型肝炎（CHC）患者是否存在甲状腺自身免疫及功能障碍，评估与干扰素（IFN）治疗相关的甲状腺疾病风险，并调查可能的治疗相关甲状腺损伤的转归。在104例连续未治疗的患者（30例女性和74例男性；平均年龄52.7岁）中，8例（7.7%）甲状腺自身抗体（ThyAb）血清学呈阳性，而健康对照者的血清学阳性率为1/98（1.3%）。与CHC相关的发生甲状腺自身免疫的风险相对增加760%（95%可信区间，220 - 1300%）。无患者甲状腺功能检查异常，但在IFN治疗时，3/3例患者循环促甲状腺素迅速超过正常范围升高，停药后恢复正常。在另外5例拒绝治疗的血清学阳性患者中，甲状腺功能保持正常。在58例最初血清学阴性且同意接受IFN治疗的患者中，9例（15.5%）发生了甲状腺自身免疫。其中7例（77.7%）有甲状腺功能障碍：4例为甲状腺功能减退，2例为短暂甲状腺毒症。最后1例患者出现促甲状腺素受体抗体和格雷夫斯病，需要甲巯咪唑治疗。前6例患者在停用IFN后甲状腺功能恢复。在28例最初血清学阴性且拒绝IFN并参与牛磺熊去氧胆酸初步试验的患者中，仅1例出现抗甲状腺球蛋白抗体，但未观察到甲状腺功能障碍。与IFN治疗相关的甲状腺自身免疫性疾病的相对风险为342%（28 - 636%）。CHC患者在未接受IFN治疗时，尽管ThyAb血清学呈阳性，但不太可能发生甲状腺功能障碍。此外，相当一部分血清学阴性患者在接受IFN治疗时会发生甲状腺自身免疫，进而出现甲状腺功能障碍。血清学阳性和血清学阴性患者在立即停用IFN后甲状腺功能均恢复正常，无需激素替代治疗。
