Case Report

Interferon Alpha-Induced Hashimoto Thyroiditis Followed by Transient Graves Disease in a Patient with Chronic HCV Infection

Authors: Savvas P. Savvas, MD, Nikolaos Papakostas, MD, Markos Giannaris, MD, Sophia Malaktari, MD, John Koskinas, MD, Athanasios J. Archimandritis, MD

Abstract


The case of a 37-year-old man with chronic hepatitis C virus (HCV) infection is presented. The patient had received a 6-month course of antiviral therapy with peg interferon alpha-2a and ribavirin, with concomitant clearance of hepatitis C virus ribonucleic acid (HCV-RNA) from serum at the end of treatment. Three months after the treatment course he developed clinical and laboratory features of hypothyroidism along with high titers of thyroid peroxidase antibodies. Later on, while on treatment with levothyroxine, he developed all the clinical features of Graves disease along with increased levels of thyroid stimulating hormone (TSH)-receptor antibodies.


This patient exhibited a rare sequence of immune-mediated thyroid disorders as a result of interferon alpha treatment. At the end of treatment, the patient developed Hashimoto thyroiditis, a typically Th1-response-mediated disease, followed sequentially after 6 months by Graves disease, a typically Th2-response-mediated disorder. Although both clinical entities have been described in patients receiving interferon-based regimens, to our knowledge, the changing pattern of immune-mediated thyroid disease in the same individual has not been reported in the literature.



This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Deutsch M, Dourakis S, Manesis EK, et al. Thyroid abnormalities in chronic viral hepatitis and their relationship to interferon alfa therapy. Hepatology 1997;26:206–210.
 
2.Mandac JC, Chaudhry S, Sherman KE, et al. The clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. Hepatology 2006;43:661–672.
 
3.Takasu N, Yamada T, Sato A, et al. Graves' disease following hypothyroidism due to Hashimoto's disease: studies of eight cases. Clin Endocrinol (Oxf) 1990;33:687–698.
 
4.Fisfalen ME, Palmer EM, Van Seventer GA, et al. Thyrotropin-receptor and thyroid peroxidase-specific T cell clones and their cytokine profile in autoimmune thyroid disease. J Clin Endocrinol Metab 1997;82:3655–3663.
 
5.Wong V, Fu AX, George J, et al. Thyrotoxicosis induced by alpha-interferon therapy in chronic viral hepatitis. Clin Endocrinol (Oxf) 2002;56:793–798.
 
6.Lisker-Melman M, Di Bisceglie AM, Usala SJ, et al. Development of thyroid disease during therapy of chronic viral hepatitis with interferon alpha. Gastroenterology 1992;102:2155–2160.
 
7.Nagayama Y, Mizuguchi H, Hayakawa T, et al. Prevention of autoantibody-mediated Graves'-like hyperthyroidism in mice with IL-4, a Th2 cytokine. J Immunol 2003;170:3522–3527.