Reactions 1260 - 11 Jul 2009

SPeginterferon-α-2b/ribavirin

Thyroiditis: case reportA 40-year-old woman with chronic hepatitis C infection

developed subacute thyroiditis during treatment withpeginterferon-α-2b [PegIntron] and ribavirin [Rebetol].

The woman had received interferon-α for 10 years,without a virological response. She started receiving a newcycle of treatment of peginterferon-α-2b, 80µg,0.5 µg/kg/week, subcutaneously, and ribavirin, 200mg,800 mg/day. At the sixth month of treatment, she started toexperience irritability, nervousness, weight loss (4kg),distal tremors, hyperorexia, and increased bowelmovements. On examination, she had a HR of130 beats/min, hot clammy skin, pseudo-exophthalmosand grade Ia goitre. Investigations showed the followinglevels: antihyroid peroxidase antibodies 355.4 U/mL,antithyroglobulin antibodies 37.8 U/mL, free thyroxine(FT4) 3.11 ng/dL, TSH 0.0075 mU/L, anti-TSH receptorantibodies < 2.5 U/L and ESR 45 mm/h. Ultrasoundshowed a slightly hypoechoic thyroid gland with non-homogeneous echogenicity.

The woman received propranolol, with an improvementin her clinical status, and peginterferon-α-2b and ribavirinwere stopped. Within a month, her FT4 level decreased to1.38 ng/dL with a TSH level of 0.0037 mU/L. One monthlater, her FT4, TSH and thyroglobulin levels were 0.4 ng/dL,4.413 mU/L and 807 ng/mL, respectively. She receivedlevothyroxine sodium and, the drug was stopped after3 months, at which point investigations showed thefollowing levels: thyroglobulin 8.51 ng/mL, thyroglobulinantibodies 640.2 U/mL, FT4 1.21 ng/dL, antithyroidperoxide antibodies 111.6 U/mL and TSH 2.93 mU/L. Twoyears later, she remained euthyroid, with an undetectableHCV viral load.Abellan Galiana P, et al. Pegylated-interferon alpha plus ribavirin-induced subacutethyroiditis in chronic hepatitis C. Endocrinologia y Nutricion 56: 136-139, No. 3,Mar 2009 [Spanish; summarised from an English translation] - Spain 801146107

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Reactions 11 Jul 2009 No. 12600114-9954/10/1260-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved