Thyroiditis During Pegylated Interferon Therapy and HbsAg Seroconvertion after the Treatment

Introduction: Interferon alfa is preferred in treatment of hepatitis B, especially for young patients, because of the greater chance of HBs Ag loss, the absence of resistance and the finite duration of treatment. But its side effects like flu like symptoms, asthenia, neuropathy, anxiety, depression, hepatotoxicity, neutropenia, thrombositopenia and throid disfunction causes poor tolerance to treatment. We described a chronic hepatitis B patient who had thyroid dysfunction during Peg-IFNα therapy.
Case: A twenty-nine year old woman admitted to hospital with hair and weight loss on fourth month of Peg-IFNα therapy while her TSH level was normal at the beginning of the treatment. AST and ALT levels were within normal limits and HBV DNA was negative, TSH was low and T3 and T4 levels were high. Anti thyroid peroxidase antibody, anti thyroglobulin antibody and TSH receptor antibody were positive. Tiroid US and radioactive iodine uptake tests were compatible with troiditis. Peg-INFα was continued and the patient was not treated for hyperthyroidism. At the eight month of Peg-INFα therapy, levothyroxine was initiated for subclinical hypothyroidism. Hepatitis B treatment ended in the 48th week. Thyroid functions were normal at the end of HBV treatment and follow-up. At the fourth year of the therapy the patient had HBs Ag seroconvertion, with Anti HBs level of 250mU/mL.
Conclusion: The patients who have Peg-IFNα treatment should be evaluated for thyroid dysfunction and probability of thyroiditis should be kept in mind. As optimal treatment duration is important for achievement of Hbs Ag seroconvertion, appropriate management of side effects is essential in these patients.

Pegile Ýnterferon Alfa Tedavisi Sýrasýnda Geliþen Tiroidit ve sonrasýnda HBsAg Serokonversiyonu

Giriþ: Kronik hepatit B tedavisinde pegile interferon grubu ilaçlar, HBs Ag kaybýnýn oral antivirallerden daha sýk geliþmesi, direnç olmamasý ve tedavi süresinin sýnýrlý olmasý nedeniyle özellikle genç hastalarda tercih edilmektedir. Grip benzeri sendrom, asteni, nöropati, anksiyete, depresyon, hepatotoksisite, nötropeni, trombositopeni ve tiroid fonksiyon bozukluðu gibi yan etkiler tedaviye uyumu zorlaþtýrmaktadýr. Bu yazýda pegile interferon alfa (Peg-IFNα) tedavisi sýrasýnda tiroidit geliþen bir kronik hepatit B hastasý sunuldu.
Olgu: Yirmidokuz yaþýndaki kadýn hasta, tedavi öncesi bakýlan tiroid fonksiyon testleri normalken, tedavinin 4. ayýnda saç dökülmesi ve kilo kaybý þikayetleri ile baþvurdu. Yapýlan tetkiklerde HBV DNA düzeyi negatif, karaciðer fonksiyon testleri normal, tiroid stimülan hormon (TSH) düzeyi düþük ve serbest T3 ve T4 deðerleri yüksekti. Hastaya yapýlan ileri tetkiklerde Anti tiroid peroksidaz (TPO) antikoru, Anti tiroglobulin (TG) antikoru ve TSH reseptör antikoru pozitif bulundu. Tiroid USG ve radyoaktif iyot uptake testi troidit ile uyumlu idi. Hipertiroidi için tedavi verilmeyen hastanýn Peg-IFNα tedavisine devam edildi. Tedavinin 8. ayýnda TSH yükselince subklinik hipotiroidi nedeniyle levotiroksin sodyum baþlandý. PegIFN-α tedavisi 48 haftaya tamamlanan hastanýn tedavi sonunda ve daha sonraki takiplerinde tiroid fonksiyonlarý normal devam etti. Takibin 4. yýlýnda HBs Ag’nin negatifleþtiði, anti HBs düzeyinin 250mU/mL olduðu görüldü.
Sonuç: Peg-IFNα tedavisi alan hastalar klinik ve laboratuar olarak tiroid fonksiyonlarý açýsýndan takip edilmeli ve tiroidit geliþme ihtimali akýlda tutulmalýdýr. Yan etki yönetiminde bu tedavinin uygun sürede verilmesinin kronik hepatit B tedavisinde Hbs Ag serokonversiyonu ihtimalini arttýracaðý unutulmamalýdýr.