Abstract
Background
The contribution of chronic hepatitis C virus (HCV) infection per se in thyroid autoimmunity and dysfunction remains controversial. We investigate the prevalence of thyroid disorders and the possible association between thyroid dysfunction and different factors in a cohort of HCV-untreated patients.
Patients and methods
A total 1050 patients with untreated HCV infection were enrolled in this study. Thyroid function tests, antiperoxidase (TPO-Ab), antithyroglobulin, thyroid ultrasound, real-time PCR to assess HCV RNA viral load, and fibroscan to determine degree of hepatic fibrosis were done.
Results
Thyroid dysfunction was found in 17.1% of patients: 11.5% hypothyroidism and 5.6% hyperthyroidism. Subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism were detected in 8.6, 2.8, 3.3, and 2.3% of patients, respectively. Thyroid ultrasound showed abnormality in 10.2% of patients. TPO-Ab and antithyroglobulin were positive in 5.1 and 6.4% of patients, respectively. TPO-Ab was more frequently positive in hyperthyroid patients compared with euthyroid (P<0.001) and hypothyroid (P<0.001) patients. Positive TPO-Ab was only significantly associated with thyroid state (P<0.001) and duration of HCV infection (P=0.02).
Conclusion
The prevalence of thyroid dysfunction is 17.1% among patients with HCV infection. Furthermore, thyroid disorder is related mainly to thyroid autoimmunity independent of age, sex, or level of viremia.
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References
Idrees S, Ashfaq UA, Idrees N. Development of global consensus sequence of HCV glycoproteins involved in viral entry. Theor Biol Med Model 2013; 10:24.
Elgharably A, Gomaa A, Crossey MME, Norsworthy PJ, Waked I, Taylor-Robinson SD. Hepatitis C in Egypt – past, present, and future. Int J Gen Med 2017; 10:1–6.
Caviglia GP, Rosso C, Fagoonee S, Cisarò F, Andrealli A, Smedile A, et al. Endocrine manifestations of chronic HCV infection. Minerva Endocrinol 2015; 40:321–329.
Mao XR, Zhang LT, Chen H, Xiao P, Zhang YC. Possible factors affecting thyroid dysfunction in hepatitis C virus-infected untreated patients. Exp Ther Med 2014; 8:133–140.
Batool N, Elahi S, Saleem N, Ashraf A. Thyroid dysfunction in non-interferon treated hepatitis c patients residing in hepatitis endemic area. Biomed Res Int 2017; 2017:2390812.
Eletreby R, Said M, Abdellatif Z, Saad Y, El Serafy M, Yosry A, et al. Prevalence of thyroid dysfunction among 21672 Egyptian patients with chronic HCV genotype IV. J Hepatol 2017; 66:S703–S704.
Goyal G, Panag K, Garg R. Prevalence of thyroid disorders in hepatitis C virus positive patients on interferon and antiviral therapy. Int J Appl Basic Med Res 2016; 6:245–248.
Fernandez-Soto L, Gonzalez A, Escobar-Jimenez F, Vazquez R, Ocete E, Olea N, 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.
Hass HG, Klein R, Nehls O, Kaiser S. Thyroid disorders and occurrence of nonorgan-specific autoantibodies (NOSA) in patients with chronic hepatitis C before and during antiviral induction therapy with consensus interferon (interferon alfacon-1). J Clin Gastroenterol 2009; 43:470–476.
Eletreby R, Said M, Abdellatif Z, Saad Y, Elserafy M, Dabes H, et al. High prevalence of HCV (GT4)-related TSH abnormality among 13402 Egyptian patients treated with direct acting antiviral therapy. Hepatol Int 2018; 12:143–148.
Akeno N, Blackard JT, Tomer Y. HCV E2 protein binds directly to thyroid cells and induces IL-8 production: a new mechanism for HCV induced thyroid autoimmunity. J Autoimmun 2008; 31:339–344.
Blackard JT, Kong L, Huber AK, Tomer Y. Hepatitis C virus infection of a thyroid cell line: implications for pathogenesis of hepatitis C virus and thyroiditis. Thyroid 2013; 23:863–870.
Menconi F, Hasham A, Tomer Y. Environmental triggers of thyroiditis: hepatitis C and interferon-α. J Endocrinol Invest 2011; 34:78–84.
Stefanova-Petrova DV, Tzvetanska AH, Naumova EJ, Mihailova AP, Hadjiev EA, Dikova RP, et al. Chronic hepatitis C virus infection: prevalence of extrahepatic manifestations and association with cryoglobulinemia in Bulgarian patients. World J Gastroenterol 2007; 13:6518–6528.
Shao C, Huo N, Zhao L, Gao Y, Fan X, Zheng Y, et al. The presence of thyroid peroxidase antibody of IgG2 subclass is a risk factor for thyroid dysfunction in chronic hepatitis C patients. Eur J Endocrinol 2013; 168:717–722.
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population(1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87:489–499.
Lucas A, Julián MT, Cantón A, Castell C, Casamitjana R, Martínez-Cáceres EM, et al. Undiagnosed thyroid dysfunction, thyroid antibodies, and iodine excretion in a Mediterranean population. Endocrine 2010; 38:391–396.
Vezali E, Elefsiniotis I, Mihas C, Konstantinou E, Saroglou G. Thyroid dysfunction in patients with chronic hepatitis C: virus- or therapy-related? J Gastroenterol Hepatol 2009; 24:1024–1029.
Salazar LA, Garcia-Samper X, Suarez-Carpio R, Jimenez-Martínez MC, Rendón-Huerta EP, Masso FA, et al. Hypothyroidism in noninterferon treated-HCV infected individuals is associated with abnormalities in the regulation of Th17 cells. Hepat Res Treat 2010; 2010:971095.
Tomer Y. Interferon induced thyroiditis. J Autoimmun 2010; 34:J322–J326.
Fallahi P, Ferrari SM, Politti U, Giuggioli D, Ferri C, Antonelli A. Autoimmune and neoplastic thyroid diseases associated with hepatitis C chronic infection. Int J Endocrinol 2014; 2014:935131.
Antonelli A, Ferri C, Pampana A, Fallahi P, Nesti C, Pasquini M, et al. Thyroid disorders in chronic hepatitis C. Am J Med 2004; 117:10–13.
Testa A, Castaldi P, Fant V, Fiore GF, Grieco V, De Rosa A, et al. Prevalence of HCV antibodies in autoimmune thyroid disease. Eur Rev Med Pharmacol Sci 2006; 10:183–186.
Muratori L, Bogdanos DP, Muratori P, Lenzi M, Granito A, Ma Y, et al. Susceptibility to thyroid disorders in hepatitis C. Clin Gastroenterol Hepatol 2005; 3:595–603.
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Fayed, A., Soliman, A., Naguib, M. et al. Thyroid dysfunction in Egyptian patients with hepatitis C virus: prevalence and possible triggering. Egypt J Intern Med 31, 678–682 (2019). https://doi.org/10.4103/ejim.ejim_64_19
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DOI: https://doi.org/10.4103/ejim.ejim_64_19