Long-term outcomes of thyroid dysfunction in patients with chronic hepatitis C treated with pegylated interferon alpha and ribavirin

ABSTRACT

INTRODUCTION: Thyroid dysfunctions (TDs) are associated with pegylated interferon and ribavirin (PegIFN-α/RBV) therapy in patients with chronic hepatitis C (CHC) and are considered as possible extrahepatic manifestation of HCV infection OBJECTIVES: This study aimed to assess the long-term outcomes of TDs in patients with CHC treated with PegIFN-α/RBV METHODS: A total of 1,047 treatment-naïve patients with CHC were treated with PegIFN-α/RBV. TSH and FT4 were assessed at baseline, every 3 months during therapy and 6, 12 and 24 months after the end of therapy. Analysis was performed for two groups of patients depending on the absence (group A, n=77) or presence (group B, n=39) of TDs at baseline RESULTS: At baseline, TDs' prevalence was 3.7%; 53.8% hypothyroidism, 38.5% goiters, and 7.7% hyperthyroidism. 77 (7.4%) out of 1,008 euthyroid patients developed TDs; 45.5% hypothyroidism, 33.8% hyperthyroidism, 19.5% destructive thyroiditis, and 1.3% goiters. TDs' remission (TDR) was achieved in 59/116 (50.9%) of treated patients; 64.9% in group A and 23.1% in group B (p<0.001). Hyperthyroidism as compared to hypothyroidism increases the odds of TDR (OR=4.87 (1.65-14.35), p=0.004), whereas preexisting TDs and higher baseline viral load tend to decrease the probability of TDR (OR=0.21 (0.07-0.58), p=0.003 and OR=0.4 (0.22-0.73), p=0.003, respectively) CONCLUSIONS: The prevalence of TDs was low but over one-third of patients in whom TDs developed under PegIFN-α/RBV therapy did not recover. In one-fourth of patients with preexisting TDs remissions were observed. Treatment with PegIFN-α in the past must be taken into account as a potential cause of TDs