Frequency of Hypothyroidism in Chronic Hepatitis C patients  treated with Standard Interferon Therapy: Hypothroidism in HCV patients on Interferon Therapy

Muhammad  Farooq; Sami Ullah  Mumtaz; Hina  Akhtar; Kanza  Ashraf; Tayyeba  Komal; Irshad Hussain   Qureshi

doi:10.52229/pbmj.v1i2.46

Authors

Muhammad Farooq Department of Medicine,District Headquarter Hospital, Hafizabad, Pakistan
Sami Ullah Mumtaz North Medical Ward, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
Hina Akhtar Department of Medicine, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
Kanza Ashraf Department of Medicine,District Headquarter Hospital, Hafizabad, Pakistan
Tayyeba Komal Department of Pathology,Services Institute of Medical Sciences, Lahore, Pakistan
Irshad Hussain Qureshi East Medical Ward, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.52229/pbmj.v1i2.46

Abstract

Chronic hepatitis C is a major health problem associated with high mortality and morbidity. It is the most common chronic blood borne infection leading to chronic liver disease and hepatocellular carcinoma. One of the treatment used for hepatitis C is interferon therapy which can lead to thyroid dysfunction i.e. hyperthyroidism and hypothyroidism. OBJECTIVE: “To assess the frequency of hypothyroidism in chronic hepatitis C patients treated with standard interferon therapy”. METHODS:Thisdescriptive case series study was carried out at Outpatient Department of Medicine, King Edward Medical University/ Mayo Hospital Lahore for 06 months from July to December 2014.After ethical approval of the study, 200 patients of ages 15 to 65 years with both genders having chronic hepatitis C on Polymerase chain reaction (PCR)& normal thyroid functionstest were taken by Non-probability, purposive sampling technique. Informed written consent was taken from all the patients. Serum thyroid stimulating hormone level (TSH) was sent of all patients to Centre for Nuclear Medicine (CENUM), Mayo Hospital Lahore before and after the completion of three months of interferontherapy and hypothyroidism was considered as TSH>4.0 mIU/L (normal range: 0.2-4.0 mIU/L). RESULTS: The mean age of the patients was 36.29 + 8.5 years. Out of total 200 patients, 123 (61.5%) were male and 77 (38.5%) were female. At baselines mean TSH of the patients was 3.16 + 2.57 mIU/L. After 3 months of therapy 163 patients (81.5%) were euthyroid and 37 patients (18.5%) were having thyroid dysfunction. Among patients with thyroid dysfunction 29 (14.5% of total patients) were hypothyroid. Among hypothyroid patients, according to gender distribution 8 (27.6%) patients were male and 21 (72.4%) patients were female. The difference was statistically significant (P=0.0003). CONCLUSION: It is concluded from this study that there is significant frequency of hypothyroidism in patients of chronic hepatitis C treated with standard interferon therapy and females are at more risk of developing thyroid dysfunction particularly hypothyroidism after standard interferon therapy.

References

Hoofnagle JH, D BisceglieAM. The Treatment of Chronic Viral Hepatitis. N Engl J Med 1997; 336:347-56.Stephen LC, Timothy RM. The natural history of hepatitis C virus (HCV) Infection.Int J Med Sci 2006; 3(2):47–52

Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States,1999 through 2002.Annals of Internal Medicine 2006; 144:705-14.

Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP.The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45(4):529-38.

Ali SA, Donahue RM, Qureshi H, Vermund SH. Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors.Int J Infec Dis 2009;13:9-19.

Waheed Y, ShafiT,Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol. 2009; 15(45):5647-53.

Bosan A, Ahmad I, Hafiz R, Qureshi H, Bile KM.A review of hepatitis viral infections in Pakistan. Journal of Pakistan medical association 2010; 60(12):1045-58.

Conjeevaram HS, Fried MW, Jeffers LJ, et al. Peg interferon and ribavirin treatment in African American and Caucasian American patients with chronic hepatitis C genotype 1. Gastroenterology 2006; 131: 470–77.

Sleijfer S, Bannink M, Van GR, Kruit WH, Stoter G. Side effects of interferon-alpha therapy. Pham World Sci 2005; 27(6):423-31.

Tomer Y, Jason T, Blackard, Akeno N. Interferon alpha treatment and thyroid dysfunction. EndocrinolMetabClin North Am. 2007; 36(4): 1051–66.

Vezali E, Elefsiniotis I, Mihas C, Konstantinou E, Saroglou JG. Thyroid dysfunction in patients with chronic hepatitis C: virus- or therapy-related?.GastroenterolHepatol. 2009; 24(6):1024-29.

Yan Z, Fan K, Fan Y, Wang X, Mao Q, Deng G et al. Thyroid Dysfunction in Chinese Patients with Chronic Hepatitis C Treated with Interferon Alpha: Incidence, Long-Term Outcomes and Predictive Factors. Hepat 2012; 12(9): e6390

Bini EJ, Mehandru S. Incidence of thyroid dysfunction during interferon alpha 2b and ribavirin therapy in men with chronic hepatitis C. Arch Intern Med 2004;164:2371-6.

Ward DL, Bing-You RG. Autoimmune thyroid dysfunction induced by interferon-alpha treatment for chronic hepatitis C: screening and monitoring recommendations. EndocrPract. 2001; 7(1):52-8.

Földes I, Dávid K, Horváth G, Osztrogonácz H, Jankovics K, Tolvaj G. Thyroid dysfunctions in patients with viral hepatitis treated with interferon-alpha. OrvHetil. 2004; 145(23):1211-6.

Kee KM, Lee CM, Wang JH, Tung HD, Changchien CS, Lu SN et al. Thyroid dysfunction in patients with chronic hepatitis C receiving a combined therapy of interferon and ribavirin: incidence, associated factors and prognosis. J GastroenterolHepatol.2006; 21:319-26.

Nadeem A, Hussain MH, Aslam M, Hussain T. Interferon-Alpha Induced and Ribavirin Induced Thyroid Dysfunction in Patients with Chronic Hepatitis C. Hepat Mon. 2010; 10(2): 132–40.

Farooqi JI, Farooqi RJ. Conventional interferon alfa-2b and ribavirin for 12 versus 24 weeks in HCV genotype 2 or 3. J Coll Physicians Surg Pak 2008; 18(10):620-4.