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Transient Hypothyroidism and Autoimmune Thyroiditis in Children with Chronic Hepatitis C Treated with Pegylated-Interferon-α-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
The 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-α-2b and ribavirin.

Methods:

61 otherwise healthy children with CHC, 3-17 years of age, infected perinatally and treatment naïve, receiving therapy with pegylated interferon-α-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-α-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-α based treatment.

Conflict of interest and source of funding: none declared

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Authors contributions: Daniele Serranti, Giuseppe Indolfi, Gabriella Nebbia, Mara Cananzi, Lorenzo D’Antiga, Stefano Stagi, Chiara Azzari and Massimo Resti created the project. Daniele Serranti, Giuseppe Indolfi, Silvia Ricci and Stefano Stagi collected the data, wrote the first draft of the article, critically revised it and gave the final approval to submission. Gabriella Nebbia, Lorenzo D’Antiga, Chiara Azzari and Massimo Resti, as experts, critically revised the article and gave the final approval to submission.

Corresponding author: Giuseppe Indolfi, MD. Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence. Viale Gaetano Pieraccini 24, Firenze, 50139, Italy. Fax: +39-055-5664000 Telephone: +39-055-5662480. Email: g.indolfi@meyer.it.

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