Subscribe to RSS
DOI: 10.1055/s-0035-1565071
Clinical Value of Thyrotropin Receptor Antibodies for the Differential Diagnosis of Interferon Induced Thyroiditis
Publication History
received 07 May 2015
first decision 18 September 2015
accepted 06 October 2015
Publication Date:
17 November 2015 (online)
Abstract
Objective: The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin.
Methods: Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis.
Results: 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 “de novo” thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (p<0.001).
Conclusion: Thyrotropin receptor antibodies determination cannot replace thyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon.
-
References
- 1 Goldstein D, Laszlo J. The role of interferon in cancer therapy: a current perspective. CA Cancer J Clin 1988; 38: 258-277
- 2 Hauschild A, Gogas H, Tarhini A et al. Practical guidelines for the management of interferon-alpha-2b side effects in patients receiving adjuvant treatment for melanoma: expert opinion. Cancer 2008; 112: 982-994
- 3 Cooksley WG. The role of interferon therapy in hepatitis B. Med Gen Med 2004; 18: 16
- 4 Fried MW, Shiffman ML, Reddy KR et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002; 347: 975-982
- 5 Russo MW, Fried MW. Side effects of therapy for chronic hepatitis C. Gastroenterology 2003; 124: 1711-1719
- 6 Mazziotti G, Sorvillo F, Stornaiuolo G et al. Temporal relationship between the appearance of thyroid autoantibodies and development of destructive thyroiditis in patients undergoing treatment with two different type-1 interferons for HCV-related chronic hepatitis: a prospective study. J Endocrinol Invest 2002; 25: 624-630
- 7 Andrade LJ, Atta AM, Atta ML et al. Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy. Braz J Infect Dis 2011; 15: 377-381
- 8 Kim BK, Choi YS, Park YH et al. Interferon-alpha-induced destructive thyroiditis followed by Graves’ disease in a patient with chronic hepatitis C: a case report. J Korean Med Sci 2011; 26: 1638-1641
- 9 Wirth S, Pieper-Boustani H, Lang T et al. Peginterferon alfa-2b plus ribavirin treatment in children and adolescents with chronic hepatitis C. Hepatology 2005; 41: 1013-1018
- 10 Kee KM, Lee CM, Wang JH et al. Thyroid dysfunction in patients with chronic hepatitis C receiving a combined therapy of interferon and ribavirin: incidence, associated factors and prognosis. J Gastroenterol Hepatol 2006; 21: 319-326
- 11 Gehring S, Kullmer U, Koeppelmann S et al. Prevalence of autoantibodies and the risk of autoimmune thyroid disease inchildren with chronic hepatitis C virus infection treated with interferon-alpha. World J Gastroenterol 2006; 28: 5787-5792
- 12 Huang JF, Chuang WL, Dai CY et al. The role of thyroid autoantibodies in the development of thyroid dysfunction in Taiwanese chronic hepatitis C patients with interferon-alpha and ribavirin combination therapy. J Viral Hepat 2006; 13: 396-401
- 13 Vasiliadis T, Anagnostis P, Nalmpantidis G et al. Thyroid dysfunction and long-term outcome during and after interferon alpha therapy in patients with chronic hepatitis C. Ann Acad Med Singapore 2011; 40: 394-400
- 14 Barut S, Gunal O, Erkorkmaz U et al. Thyroid dysfunction in Turkish patients with chronic hepatitis C receiving peginterferon plus ribavirin in the period of 2005–2010. Braz J Infect Dis 2012; 16: 448-451
- 15 Dabrowska MM, Panasiuk A, Flisiak R. Thyroid dysfunction in antiviral therapy of chronic hepatitis C. Hepatogastroenterol 2010; 57: 826-831
- 16 Mandac JC, Chaudhry S, Sherman KE et al. The clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. Hepatology 2006; 43: 661-672
- 17 Mazziotti G, Sorvillo F, Piscopo M et al. Innate and acquired immune system in patients developing interferon alpha-related autoimmune thyroiditis: a prospective study. J Clin Endocrinol Metab 2005; 90: 4138-4144
- 18 Tozzoli R, Bagnasco M, Giavarina D et al. TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev 2012; 12: 107-113
- 19 Ghany MG, Strader DB, Thomas DL et al American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009; 49M: 1335-1374
- 20 Carrión JA, Gonzalez-Colominas E, García-Retortillo M et al. A multidisciplinary support programme increases the efficiency of pegylated interferon alfa-2a and ribavirin in hepatitis C. J Hepatol 2013; 59: 926-933
- 21 Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996; 24: 289-293
- 22 Bahn Chair RS, Burch HB, Cooper DS et al American Thyroid Association; AmericanAssociation of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21: 593-646
- 23 Pearce EN, Hennessey JV, McDermott MT. New American Thyroid Association and American Association of Clinical Endocrinologists guidelines for thyrotoxicosis and other forms of hyperthyroidism: significant progress for the clinician and a guide to future research. Thyroid 2011; 21: 573-576
- 24 Wong V, Fu AX, George J et al. Thyrotoxicosis induced by alpha-interferon therapy in chronic viral hepatitis. Clin Endocrinol (Oxf) 2002; 56: 793-798
- 25 Fernandez-Soto L, Gonzalez A, Escobar-Jimenez F et al. Increased risk of autoimmune thyroid disease in hepatitis C vs. hepatitis B before, during, and after discontinuing interferon therapy. Arch Intern Med 1998; 158: 1445-1448
- 26 Roti E, Minelli R, Giuberti T et al. Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alfa. Am J Med 1996; 101: 482-487
- 27 Carella C, Amato G, Biondi B et al. Longitudinal study of antibodies against thyroid in patients undergoing interferon-alpha therapy for HCV chronic hepatitis. Horm Res 1995; 44: 110-114
- 28 Baudin E, Marcellin P, Pouteau M et al. Reversibility of thyroid dysfunction induced by recombinant alpha interferon in chronic hepatitis C. Clin Endocrinol (Oxf) 1993; 39: 657-661
- 29 Nair Kesavachandran C, Haamann F, Nienhaus A. Frequency of thyroid dysfunctions during interferon alpha treatment of single and combination therapy in hepatitis C virus-infected patients: a systematic review based analysis. PLoS One 2013; 8: 553-564