Mehmet VATANSEVER, CÜNEYT ARDIÇ, Mehmet ZORLU, Muharrem KISKAÇ, Ferhat YILMAZ, Mustafa YENİGÜN

Kronik Hepatit C hastalarında pegile interferon-ribavirin kombinasyon tedavisinin tiroid fonksiyonları ve tiroid otoimmunitesi üzerine etkileri

Amaç: Hepatit C virusu ve interferon hastalarda otoimmüniteyi tetikleyebilir. Kronik hepatit-C (KCH) hastalarında peginterferon alfa (Peg İFN-α) + ribavirin kombinasyon tedavisinin tiroid fonksiyon testleri ve tiroid otoantikorları üzerine olan etkilerini arastırmayı amaçladık. Gereç ve yöntem: Çalısma grubu KCH kanıtlanmıs, daha önce tedavi edilmemis, tiroid fonksiyonları baslangıçta normal ve tiroid otoantikorları negatif olan 45 hastadan olusturuldu. Tüm hastalar peg-IFN+ ribavirin kombinasyonu ile tedavi edildi. Tedavi baslangıcında ve tedavinin 1., 3., ve 6. aylarında bütün hastalarda serbest triiodotironin (sT3), serbest tiroksin (sT4), tiroid stimülan hormon (TSH) , antitiroglobülin (Anti-Tg), tiroid peroksidaz otoantikoru (Anti-TPO) değerleri ölçüldü. Tiroid disfonksiyonu görülme sıklığı, yas ve cinsiyete göre değerlendirildi. Bulgular: Toplam 45 hastadan 15’inde (%33.3) altı aylık antiviral tedavi sonunda tiroid disfonksiyonu gelisti ve iki hastada semptomatik tiroid hastalığı görüldü. Bir aylık tedavi sonunda 2 hastada subklinik hipotiroidi görüldü. Üç aylık tedavi sonunda 4 hastada subklinik hipertiroidi (%8.9), 3 hastada (%6.7) subklinik hipotiroidi gözlemlendi. Altı aylık tedavi sonunda ise toplam bir hastada semptomatik hipertiroidi (%2.2), 6 hastada subklinik hipertiroidi (%13.3), 7 hastada subklinik hipotiroidi (%15.6), bir hastada ise semptomatik hipotiroidi (%2.2) görüldü. Oniki hastada (%26.7) 6 aylık antiviral tedavi sonunda antitiroglobülin (anti-Tg) otoantikorları pozitifl esti. Onbir hastada (4 erkek, 7 kadın) (%24.5) 6 aylık antiviral tedavi sonunda tiroid peroksidaz otoantikorları (anti-TPO) pozitifl esti. Tiroid disfonksiyonu ile yas, cinsiyet ve ALT aktivitesi arasında anlamlı bir iliski bulunmadı (p > 0.05). Sonuç: Peg-IFN alfa 2a veya 2b + ribavirin kombinasyon tedavisi alan KCH hastalarının tiroid otoimmunitesi açısından belirli periyotlarla izlenmesi ve otoantikorları pozitifl esen hastalar tiroid disfonksiyonu açısından takip edilmelidir.

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 autoimmunity. 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 patients (%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 hyperthyroidism 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 antiTPO in 11 patients (4 male and 7 female) (%24.5). No signifi cant relationship was found between thyroid dysfunction 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 PegINF+ribavirin.

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