Friday, November 30, 2012

Full Text - Thyroid Disease in Chronic Hepatitis C Infection Treated with Combination Interferon-α and Ribavirin: Management Strategies and Future Perspective.

Thyroid Disease in Chronic Hepatitis C Infection Treated with Combination Interferon-α and Ribavirin: Management Strategies and Future Perspective.

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Authors
Huy A. Tran, FRCPA, FFSc, FACB, FRACP, FACE1, 2, Tracey L Jones, RN3, Elizabeth A Ianna, RN3, Aidan Foy, MD, FRACP4, Glenn E M Reeves, FRCPA, FRACP2, 5

1Department of Clinical Chemistry, Hunter Area Pathology Service, Newcastle, New South Wales, Australia
2 University of Newcastle, Newcastle, New South Wales, Australia
3Department of Gastroenterology, Hunter Area Pathology Service, Newcastle, New South Wales
4Department of General Medicine, Calvary Mater Hospital, Newcastle, New South Wales, Australia
5Department of Immunopathology, Hunter Area Pathology Service, Hunter Region Mail Centre, Locked Bag 1, Newcastle, New South Wales, Australia

Abstract
Objective: Hepatitis C infection is one of the major epidemics afflicting young people in both the developed and developing countries in the 21st century. The commonest endocrine disorder associated with this infection, especially in conjunction with interferon-α based therapy is thyroid disease. This manuscript aims to review the development of thyroid disease before, during and after the completion of treatment with combination interferon-α and ribavirin for chronic hepatitis C infection. We also aim to summarise the current understanding of the natural history of the condition and propose management and follow-up guidelines.

Methods: PubMed was searched up to June 30th, 2011 for English-language publications that contained the search terms "hepatitis C virus", "chronic hepatitis C", "HCV", "thyroid disease", "thyroiditis", "autoimmunity", "interferon-alpha" and "ribavirin". Additional publications were identified from the reference lists of papers identified by this search. All studies must be original research publications and included combination interferon-α and ribavirin use in whom thyroid disease developed. All available manuscripts were reviewed and critically analysed.

Results: The prevalence of thyroid disease before combination IFN-α and Ribavirin therapy ranges from 4.6 to 21.3%; during therapy 1.1 to 21.3% and after therapy 6.7 to 21.3%. The commonest thyroid disease is thyroiditis. The frequency of thyroid testings and diagnostic criteria for the various thyroid conditions are not standardised and many publications are retrospective.

Conclusion: Patients undergoing this therapy should have a strictly standardised protocol in order to detect and manage developed thyroid disease appropriately. However, current published reports are heterogeneous and inconsistent. Based on current available literature, we recommend monthly screening test with thyrotropin level whilst receiving combination interferon-α and ribavirin therapy. Free thyroid hormone parameters can be sequentially be performed if thyrotropin levels are abnormal.

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