methimazole and Hepatitis-C--Chronic

Agranulocytosis is a life-threatening disorder characterised by a greatly decreased number of circulating neutrophils below 500/μL. This article presents two cases of agranulocytosis in patients treated with pegylated interferon and ribavirin due to chronic hepatitis C. Interferon induced hyperthyroidism, which required the use of a tyreostatic. Anti-thyroid drugs (ATD) used to treat hyperthyroidism can cause agranulocytosis. The synergistic reaction of ATD and interferon on bone marrow cannot be excluded.

Topics: Adult; Agranulocytosis; Antithyroid Agents; Antiviral Agents; Drug Therapy, Combination; Female; Hepatitis C, Chronic; Humans; Hyperthyroidism; Interferon alpha-2; Interferon-alpha; Methimazole; Middle Aged; Polyethylene Glycols; Propylthiouracil; Recombinant Proteins; Ribavirin; Time Factors; Viral Load

Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-α therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-α therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-α therapy and remained weakly positive after IFN-α therapy was discontinued.

Topics: Adult; Antiviral Agents; Female; Graves Disease; Hepatitis C, Chronic; Humans; Interferon-alpha; Methimazole; Propranolol; Thyroiditis

An association between Graves' disease (GD) and chronic hepatitis C (C-HC) has been observed both in the presence and the absence of recombinant interferon-alpha (rIFN-alpha) treatment. rIFN-alpha-induced GD is characterized by suppressed thyroid-stimulating hormone levels; normal or elevated free triiodothyronine (FT3) and free thyroxine (FT4) values; the presence of thyroid peroxidase antibodies, antithyroglobulin antibodies, and thyroid receptor antibodies; and high iodine thyroid uptake. In contrast, GD developed during C-HC without rIFN-alpha is less clearly defined. In this study, we examined two groups of patients: group A, 28 patients with C-HC treated with rIFN-alpha who developed GD after 1 to 9 months, and group B, 10 patients with C-HC who developed GD without a previous rIFN-alpha treatment. At the time of GD, both groups started methimazole therapy; thyroid function was reevaluated after 3, 6, 9, and 12 months. Group A patients continued IFN. After 12 months, all patients of group A were euthyroid, and 21 of them (75%) had already stopped methimazole treatment, whereas all patients of group B were euthyroid and only 2 (20%) had stopped methimazole. In conclusion, the data show a better course of GD, with a more precocious and significantly higher number of recoveries in patients with rIFN-alpha-induced GD than in rIFN-alpha-unrelated disease. Further studies are needed to establish whether the two types of GD differ not only from a clinical point of view but also because of different underlying pathogenetic mechanisms.

Topics: Antiviral Agents; Autoantibodies; Female; Graves Disease; Hepacivirus; Hepatitis C, Chronic; Humans; Interferon Type I; Iodide Peroxidase; Male; Methimazole; Middle Aged; Receptors, Thyroid Hormone; Recombinant Proteins; Thyrotropin; Thyroxine; Treatment Outcome; Triiodothyronine

Topics: Adult; Antiviral Agents; Early Diagnosis; Female; Graves Disease; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Methimazole; Polyethylene Glycols; Recombinant Proteins; Treatment Outcome