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01-06-2006 | Infectious disease | Article

Central hypothyroidism listed as hepatitis C treatment side-effect


Free abstract

Central hypothyroidism and hypophysitis should be considered as potential side effects of treatment with pegylated (PEG) interferon (IFN)-α plus ribavirin in patients with hepatitis C virus (HCV) infection, Argentinean researchers state.

While thyroid dysfunction is a known complication of IFN treatment in patients with HCV infection, the prevalence of thyroid disorders among individuals who receive a newer treatment, comprising PEG IFN-α plus ribavirin, is not known.

The researchers, led by Ezequiel Ridruejo, from the Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno in Buenos Aires, have reported the case of a 54-year old woman who developed central hypothyroidism and hypophysitis during PEG IFN-α plus ribavirin therapy for HCV infection.

They note that before treatment, the patient had normal thyroid-stimulating hormone (TSH) and free serum thyroxine (T4) levels. She began therapy with PEG IFN-α 2-a 180 μg/week plus ribavirin 1000 mg/day.

After 20 weeks of treatment, testing revealed that the patient had low levels of TSH and free T4, at less than 0.06 mul/ml and 0.47 ng/dl, respectively.

Other examinations indicated that she had low levels of triiodothyronine and T4. She also had depreciated levels of follicle-stimulating hormone, luteinizing hormone, prolactin, and adrenocorticotrophic hormone (ACTH), indicating hypothalamic dysfunction.

A radionuclide scan showed that the woman had a morphologically normal thyroid gland, but a magnetic resonance imaging scan indicated inflammatory lesions of the pituitary gland, known as hypophysitis.

This finding suggests a diagnosis of central hypothyroidism, caused by dysfunction of the hypothalamic-pituitary system, rather than of the thyroid gland, the investigators note.

After 24 weeks of HCV treatment, the patient had negative HCV RNA and liver alanine aminotransferase levels within the normal range. However, she continued to take PEG IFN-α plus ribavirin and her thyroid values remained at the "lower limits of normal."

Treatment finished after 48 weeks. Twenty-four weeks after the cessation of therapy, ACTH and thyroid values returned to within the normal range, and her hypophysitis spontaneously resolved.

"This is the first report of central hypothyroidism and hypophysitis during treatment with PEG-IFN-α plus ribavirin, and may be included in the potential list of side effects of the combination treatment," Ridruejo et al conclude in the European Journal of Gastroenterology & Hepatology.