Introduction: Chronic Hepatitis C is highly prevalent in our country.
Management involves combination treatment with pegylated interferon and ribavirin. Thyroid disease in affected patients can be caused by the hepatitis C virus or by the interferon therapy.
Aims and method: The study aims to investigate thyroid dysfunction and optimal management strategies for patients with chronic hepatitis C treated with pegylated interferon and ribavirin. A prospective study of 68 patients with chronic hepatitis C was undertaken. Patients commenced treatment between1st January 2003 1st January 2005. Patients with previous thyroid pathology were excluded from the study. All patients were followed up at 3, 6, 8 and 12 months from starting therapy. Patients were investigated using thyroid echography, TSH, fT3 and fT4 measurement, as well as anti-thyroid anti-body (anti-thyroglobulin and anti-peroxidase) and anti-TSH receptor antibodies assessment.
Results: 11 patients (16.17%) developed thyroid pathology: 7 patients developed hypothyroidism and 4 developed hyperthyroidism. Of the latter, 3 developed destructive thyrotoxicosis and one developed Graves disease.6 patients (54.54%) were asymptomatic (especially those with hypothyroidsim), whilst 75% of those with hyperthyroidism were symptomatic. 3 out of 7 patients with hypothyroidism developed antithyroid antibodies, probably due to an undiagnosed destructive thyroiditis. Only 2 patients (18.18% of those with thyroid pathology and 2.94% of all patients) stoped peginterferon treatment due to the thyroid related side effects.
Conclusion: The prevalence of thyroid dysfunction in chronic hepatitis C treated with pegylated interferon and ribavirin is 16.17%, mostly manifesting as hypothyroidism. The majority of patients are asymptomatic. Few patients required cessation of antiviral treatment. Monitoring of thyroid function during antiviral therapy is compulsory.