Autoimmune and non-autoimmune thyroid dysfunction in HCV infected and HCV-HIV co-infected patients before and after interferon alpha therapy: A prospective study.

INTRODUCTION: Autoimmune thyroid diseases are reported in no treated hepatitis C virus (HCV) infection. The standard interferon alpha (IFNα) treatment is associated with an increase of thyroid damage and dysfunction. The present cohort prospective study compared thyroid function and autoimmunity in HCV patients' monoinfected and coinfected HCV-HIV at baseline, during and after IFNα therapy. METHODS: We studied 790 HCV infected patients: G1 (monoinfected HCV: N=580) and G2 (HCV-HIV coinfected: N=210). They were evaluated for thyroid function and thyroid tiroperoxidase antibodies (TPOAb) at baseline and 235 patients (G1: 183; G2: 52) post IFNα therapy. If thyroid dysfunction (TD) was diagnosed, they were reevaluated at 12 month after discontinuation to determine whether the TD was transitory or definitive. RESULTS: No difference was found in the prevalence of TD at baseline in G1 (7.6%) and G2 (9%). However, monoinfected patients showed a higher prevalence of TPOAb positivity with a women preponderance in this group. There was no difference in TD between both groups during IFNα therapy (G1 23.5% vs G2 19.2%). In G1 the autoimmune TD was higher than in G2 (67.4% vs 30%, p=0.02). Autoimmune TD during IFNα tended to evolve to definitive hypothyroidism and non-autoimmune TD recovered euthyroidism after IFNα discontinuation. The presence of positive TPOAb (RR 3.55) and female gender (RR 2.4) were associated with the development of TD with IFNα therapy. CONCLUSION: Our hypothesis is the importance of HCV in G1 and G2, combined with IFNα in triggering TD and TPOAb positivity, not described in other diseases' applications.

Autoimmune and non-autoimmune thyroid dysfunction in HCV infected and HCV-HIV co-infected patients before and after interferon alpha therapy: A prospective study / Disfunción tiroidea autoinmune y no autoinmune en pacientes monoinfectados con VHC y coinfectados con VIH, antes y después del tratamiento con interferón alfa: un estudio prospectivo

INTRODUCTION: Autoimmune thyroid diseases are reported in no treated hepatitis C virus (HCV) infection. The standard interferon alpha (IFNΑ) treatment is associated with an increase of thyroid damage and dysfunction. The present cohort prospective study compared thyroid function and autoimmunity in HCV patients' monoinfected and coinfected HCV-HIV at baseline, during and after IFNΑ therapy. METHODS: We studied 790 HCV infected patients: G1 (monoinfected HCV: N = 580) and G2 (HCV-HIV coinfected: N = 210). They were evaluated for thyroid function and thyroid tiroperoxidase antibodies (TPOAb) at baseline and 235 patients (G1: 183; G2: 52) post IFNΑ therapy. If thyroid dysfunction (TD) was diagnosed, they were reevaluated at 12 month after discontinuation to determine whether the TD was transitory or definitive. RESULTS: No difference was found in the prevalence of TD at baseline in G1 (7.6%) and G2 (9%). However, monoinfected patients showed a higher prevalence of TPOAb positivity with a women preponderance in this group. There was no difference in TD between both groups during IFNΑ therapy (G1 23.5% vs G2 19.2%). In G1 the autoimmune TD was higher than in G2 (67.4% vs 30%, p = 0.02). Autoimmune TD during IFNΑ tended to evolve to definitive hypothyroidism and non-autoimmune TD recovered euthyroidism after IFN #913; discontinuation. The presence of positive TPOAb (RR 3.55) and female gender (RR 2.4) were associated with the development of TD with IFNΑ therapy. CONCLUSIÓN: Our hypothesis is the importance of HCV in G1 and G2, combined with IFNΑ in triggering TD and TPOAb positivity, not described in other diseases' applications

INTRODUCCIÓN: El presente estudio prospectivo de cohorte evaluó y comparó la función y la autoinmunidad tiroidea en pacientes con virus de la hepatitis C (VHC) monoinfectados y coinfectados con VHC-virus de la inmunodeficiencia humana (VIH) al inicio, durante y después de la terapia estándar con interferón alfa (IFNΑ). MÉTODOS: Se estudiaron 790 pacientes infectados por VHC: G1 (VHC monoinfectados: N = 580) y G2 (coinfección por VHC-VIH: N = 210). Se evaluó la función tiroidea y los anticuerpos anti-tiroperoxidasa (ATPO) al inicio del estudio, y a 235 pacientes tratados con IFNΑ (G1: 183; G2: 52). Si se diagnosticó disfunción tiroidea (DT), estos fueron reevaluados 12 meses posteriores al tratamiento para determinar si esta era transitoria o definitiva. RESULTADOS: No se encontraron diferencias en la prevalencia de DT en forma basal G1 (7,6%) vs. G2 (9%). Los pacientes monoinfectados mostraron una mayor prevalencia de positividad de ATPO, siendo preponderante el sexo femenino en el G1. No hubo diferencias en la DT entre ambos grupos con IFNΑ (G1 23,5 vs. G2 19,2%). En G1, la DT autoinmune fue mayor que en G2 (67,4 vs. 30%; p = 0,02). La DT autoinmune con IFNΑ tendió a evolucionar hacia un hipotiroidismo definitivo, mientras que la DT no autoinmune fue transitoria. Tuvieron mayor riesgo de DT durante el tratamiento los pacientes que presentaban ATPO positivos previos (RR: 3,55) y el sexo femenino (RR: 2,4). CONCLUSIONES: Planteamos como hipótesis la importancia del VHC en G1 y G2, combinado con IFNΑ en el desarrollo de la DT y positividad de los ATPO, no descripta en su uso en otras enfermedades

Tiroideopatías y deficiencia de yodo en una población de embarazadas / Thyroid disorders and iodine deficiency in a pregnant population

INTRODUCCION: La disfunción, autoinmunidad tiroidea (AIT) y el déficit de yodo en embarazo, conllevan a efectos adversos. En ausencia de datos de prevalencia y rangos de Tirotrofina (TSH) en cada trimestre en Argentina, se utilizan las guías internacionales de la American Thyroid Association (ATA).OBJETIVOS: Determinar a) prevalencia de AIT y deficiencia de yodo por pesquisa en embarazadas sanas y b) valores de referencia de TSH por trimestre y prevalencia de disfunción con valores propios. METODOS: Se estudió a 217 embarazadas sanas.Se determinó TSH, T4 y T3 total y libres, Anticuerpos a tiroperoxidasa (ATPO) y yoduria. Excluidas las ATPO positivos y disfunción clínica, se recalculó percentiles 5 y 95 y se establecieron rangos de TSH. Se establecieron porcentajes de valores patológicos de TSH según rangos publicados y propios. RESULTADOS: Los ATPO fueron positivos en 8% de las pacientes. Se halló bocio en 38%. La yoduria fue >150 μgr/dl en 58%. Los valores de TSH (mediana y rango) fueron: 0,95 uUI/ml (0,20-3,30), 1,50 uUI/ml (0,02-7,00) y 1,60 uUI/ml (0,21-4,90) para primer, segundo y tercer trimestre respectivamente. La TSH fue elevada según guías ATA en el 11% y disminuyó a 6,5% con nuestros rangos. Solo 1 paciente presentó hipotiroidismo clínico.CONCLUSIONES: La prevalencia de ATPO fue similar a la referida y casi el 40% presentó bocio leve, considerado adaptativo. Se registróhipotiroidismo clínico en 0,5% y subclínico en 11% según valoresde guías ATA, que descendió al 6,5% acorde a valores de este estudio. La mediana de la yoduria indicó suficiencia de yodo en la población.

INTRODUCTION: The dysfunction, thyroid autoimmunity (AIT) and iodine deficiency in pregnancy, leading toadverse effects. In the absence of prevalence data and ranges of Thyrotropin (TSH) in each quarter in Argentina, international guidelines of American Thyroid Association (ATA) are used. OBJECTIVES: To determine a) prevalence of AIT, thyroid dysfunctionand iodine deficiency by screening in healthy pregnant b) TSH reference values per quarter and prevalence of dysfunction with own values. METHODS: We studied 217 healthy pregnant. TSH, T4 and T3 total and free, antibodies to thyroid peroxidase (ATPO) and urinary iodine was determined. Excluding positive ATPO and clinical dysfunction, 5th and 95th TSH percentiles wasrecalculated and established own TSH ranges. Percentage of pathological TSH values was established according to published ranges and with own values. RESULTS: ATPO were positive in 8% of patients. Goiter was found in 38%. The iodine level was> 150 μgr / dl in 58%. TSH values (median and range) were: 0.95 mIU / ml (0.20- 3.30), 1.50 mIU / ml (0.02-7.00) and 1.60 mIU / ml (0.21-4.90) for the first quarter, the second and third respectively. The TSH was elevated as guides ATA in 11% and in 6.5% as own values. Only one patient had clinical hypothyroidism. CONCLUSIONS: The prevalence of ATPOwas similar to that reported, and almost 40% had mild goiter, considered adaptive. Clinical hypothyroidism was recorded at 0.5% and subclinical in 11% as guides ATA, which fell to 6.5%as own values. The median urinary iodine indicated iodine sufficiency in the population.