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Transient Hypothyroidism and Autoimmune Thyroiditis in Children with Chronic Hepatitis C Treated with Pegylated-Interferon-[alpha]-2b and Ribavirin.

Serranti, Daniele MD; Indolfi, Giuseppe MD; Nebbia, Gabriella MD; Cananzi, Mara MD; D’Antiga, Lorenzo MD; Ricci, Silvia MD; Stagi, Stefano MD; Azzari, Chiara MD, PhD; Resti, Massimo MD; for the Italian Study Group for Treatment of Chronic Hepatitis C in Children
Pediatric Infectious Disease Journal: Post Acceptance: September 22, 2017
doi: 10.1097/INF.0000000000001791
Original Studies: PDF Only

Background: Autoimmune thyroid disease and thyroid dysfunction are common in adults receiving interferon-based treatment for chronic hepatitis C (CHC). Few data are available in children with CHC. This study is aimed to evaluate the appearance and timing of thyroid dysfunction and anti-thyroid autoimmunity in children with CHC treated with pegylated interferon-[alpha]-2b and ribavirin.

Methods: 61 otherwise healthy children with CHC, 3-17 years of age, infected perinatally and treatment naive, receiving therapy with pegylated interferon-[alpha]-2b and ribavirin and 183 age- and sex-matched controls were included in a multicenter, prospective, case-control study. Thyroid-stimulating hormone, free thyroxine, anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies were assessed before, during and 24 weeks after the end of treatment.

Results: From baseline to the end of treatment subclinical hypothyroidism and autoimmune thyroiditis were diagnosed in 17/61 (27.94%) and in 4/61 (6.6%) of the children treated, respectively, and in 5/183 (2.7%) and in none of the controls [p < 0.0001, relative risk (RR): 10.2, 95% confidence interval (CI): 3.9 to 26.5; p = 0.03, RR: 26.8, 95% CI: 1.5 to 489.1, respectively]. Twenty-four weeks after the end of treatment subclinical hypothyroidism persisted in only 4/61 (6.6%). Autoimmune thyroiditis persisted in 3/4 (75%) of the cases.

Conclusions: Subclinical hypothyroidism is common in children with CHC receiving treatment with pegylated interferon-[alpha]-2b and ribavirin, but in most cases is transient. Autoimmune thyroiditis, which is less common, generally persists after treatment completion. Thyroid function should be carefully monitored in patients presenting with anti-thyroid autoantibodies and thyroid dysfunction during and after pegylated interferon-[alpha] based treatment.

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