Kronik Hepatit C hastalarinda pegile interferon-ribavirin kombinasyon tedavisinin tiroid fonksiyonlari ve tiroid otoimmunitesi üzerine etkileri/Impacts of pegylated interferon-ribavirin combination treatment on thyroid functions and thyroid autoimmunity in patients with chronic hepatitis C

Objectives: Hepatitis C and interferon may trigger autoim- munity. We aimed to investigate the effects of combination treatment of peginterferon alpha (peg-IFN) + ribavirin in patients with chronic hepatitis C (CHC) on thyroid function tests and thyroid auto antibodies. Materials and Methods: The study included 45 outpatients with proven CHC having normal thyroid functions and previously not treated. The patients received combination of Peg IFN+ribavirin. Values of fT3, fT4, TSH, antitiroglobulin (Anti-Tg) and thyroid peroxidase antibody (Anti-TPO) were measured at initial, fi rst, third and sixth months of treatment. Frequency of thyroid dysfunction was evaluated according to age and gender of patients. Results: Thyroid dysfunction emerged in 15 (%33.3) of 45 patients at the end of the six month of antiviral treatment. Symptomatic thyroid disease was confi rmed in 2 patients. Subclinical hyperthyroidism was determined in four pa- tients (%8.9), and subclinical hypothyroidism in 3 patients (%6.7) at the end of third month. At the end of sixth month; symptomatic hyperthyroidism was observed in one patient (%2.2), subclinical hyperthy- roidism in six (%13.3) and subclinical hypothyroidism in 7 patients (%15.6), and symptomatic hypothyroidism was determined in one patient (%2.2). At the end of the sixth month of antiviral treatment; Anti-Tg antibodies were positive in 12 patients (%26.7) and anti- TPO in 11 patients (4 male and 7 female) (%24.5). No sig- nifi cant relationship was found between thyroid dysfunc- tion and age, gender and ALT levels of patients (p>0.05). Conclusion: Periodic follow-up examinations should be done for thyroid autoimmunity and thyroid functions in CHC patients receiving combination treatment of Peg- INF+ribavirin. Key words: Hepatitis C, peg-interferon, ribavirin, antitiro- globulin, thyroid peroxidase antibodies, autoimmunity. ÖZET. Amaç: Hepatit C virusu ve interferon hastalarda otoimmü- niteyi tetikleyebilir. Kronik hepatit-C (KCH) hastalarinda pe- ginterferon alfa (Peg IFN-a) + ribavirin kombinasyon tedavi- sinin tiroid fonksiyon testleri ve tiroid otoantikorlari üzerine olan etkilerini arastirmayi amaçladik. Gereç ve yöntem: Çalisma grubu KCH kanitlanmis, daha önce tedavi edilmemis, tiroid fonksiyonlari baslangiçta nor- mal ve tiroid otoantikorlari negatif olan 45 hastadan olus- turuldu. Tüm hastalar peg-IFN+ ribavirin kombinasyonu ile tedavi edildi. Tedavi baslangicinda ve tedavinin 1., 3., ve 6. aylarinda bütün hastalarda serbest triiodotironin (sT3), ser- best tiroksin (sT4), tiroid stimülan hormon (TSH) , antitirog- lobülin (Anti-Tg), tiroid peroksidaz otoantikoru (Anti-TPO) degerleri ölçüldü. Tiroid disfonksiyonu görülme sikligi, yas ve cinsiyete göre degerlendirildi. Bulgular: Toplam 45 hastadan 15'inde (%33.3) alti aylik antiviral tedavi sonunda tiroid disfonksiyonu gelisti ve iki hastada semptomatik tiroid hastaligi görüldü. Bir aylik te- davi sonunda 2 hastada subklinik hipotiroidi görüldü. Üç aylik tedavi sonunda 4 hastada subklinik hipertiroidi (%8.9), 3 hastada (%6.7) subklinik hipotiroidi gözlemlendi. Alti ay- lik tedavi sonunda ise toplam bir hastada semptomatik hi- pertiroidi (%2.2), 6 hastada subklinik hipertiroidi (%13.3), 7 hastada subklinik hipotiroidi (%15.6), bir hastada ise semp- tomatik hipotiroidi (%2.2) görüldü. Oniki hastada (%26.7) 6 aylik antiviral tedavi sonunda antitiroglobülin (anti-Tg) otoantikorlari pozitifl esti. Onbir hastada (4 erkek, 7 kadin) (%24.5) 6 aylik antiviral tedavi sonunda tiroid peroksidaz otoantikorlari (anti-TPO) pozitifl esti. Tiroid disfonksiyonu ile yas, cinsiyet ve ALT aktivitesi arasinda anlamli bir iliski bu- lunmadi (p > 0.05). Sonuç: Peg-IFN alfa 2a veya 2b + ribavirin kombinasyon tedavisi alan KCH hastalarinin tiroid otoimmunitesi açisin- dan belirli periyotlarla izlenmesi ve otoantikorlari pozitifl esen hastalar tiroid disfonksiyonu açisindan takip edilmelidir. Anahtar kelimeler: hepatit C, peg-interferon, ribavirin, anti- tiroglobülin, tiroid peroksidaz otoantikorlari, otoimmünite.

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