ICEECE2012 Poster Presentations Thyroid (non-cancer) (188 abstracts)
A rare case of interferon-α-induced hyperthyroidism in a patient with chronic hepatitis C with granulocytopaenia and transaminasemia treated successfully with radioiodine
A. Czarnywojtek , J. Waligorska-Stachura , E. Szczepanek-Parulska , M. Zgorzalewicz-Stachowiak , I. Bereszynska , P. Kurdybacha , A. Stangierski , J. Harasymczuk , E. Florek , R. Wasko & M. Ruchala
University of Medical Sciences, Poznan, Poland.
Background: Conventional management of Interferon-α-Induced Hyperthyroidism (IIH) with radioactive iodine (RAI) may be used when treatment with β blockers or antithyroid drugs (ATD), proves ineffective or is contraindicated.
Case presentation: We present a 38-year-old woman who has been treated with combined pegylated interferon alpha (INF-α) and Ribavirin for chronic hepatitis C. Destructive thyrotoxicosis appeared after four months of continuous IFN-α therapy and a β blocker was prescribed. Initially, the patient presented normal TSH 2.4 μIU/ml, however during therapy with INF-α, TSH diminished to 0.05 and thyroid hormones were elevated: fT4 23.1 pmol/l, fT3 7.2 pmol/L. Ultrasound examination showed completely irregular and greatly decreased echogenicity of the thyroid gland. The radioiodine uptake (RAIU) was deeply decreased to 2 and 3% at 5 h and 24 h, respectively. The thyroid scintiscan showed lack of isotope accumulation. Hypothyroidism developed and L-thyroxine was prescribed. The following year, hyperthyroidism reoccurred with TSH 0.08 μIU/ml, fT4 26.4 pmol/l, fT3 8.2 pmol/l, positive TSHR-Abs 6.2 (normal <2 IU/l) and mild Graves’ Ophthalmopathy (GO). RAIU values were 23% at 5 h and 46% at 24 h. Thyroid scintiscan showed diffuse goiter. At this point β blocker was introduced and ATD was started. After three months of therapy an increased level of aminotransferases and granulocytopaenia were observed. Hence, the patient received RAI and glucocorticosteroid, while INF-α therapy was continued. After approximately 4 months, hypothyroidism reappeared with insignificantly raised TSH level. One year later the patient was euthyroid and required no further treatment.
Conclusions: Our report suggests that: i) radioiodine therapy might be an effective and safe method of treatment in cases of IIH with mild GO. ii) IFN-α therapy need not be discontinued in patients with IIH.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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