Endocrine Abstracts

Introduction: Interferon treatment for hepatitis C has been associated with Graves’-like thyroiditis, developing in rare instances severe ophthalmopathy. The usual management is interferon withdrawal and high-dose corticosteroids, but it may interfere with the resolution of hepatitis. Hereby we report a case successfully treated with radiotherapy, which in our knowledge has never been previously reported.

Case report: A 52-year-old woman was diagnosed of chronic hepatitis C (serotype 1) and began treatment with pegylated Interferon Alpha-2A (Pegasys, 180 μg weekly) and ribavirin (1200 mg per day), After a year, she achieved clinical, biochemical and virological remission and the treatment was withdrawn. In the last month of antiviral treatment, the patient reported symptoms of hyperthyroidism, eyelid swelling and diplopia. TSH was suppressed and free T₄ was 2.27 ng/dl. Tc-99 m scintigraphy showed irregular uptake with cold areas. The ultrasonography showed multinodular goiter, and the FNAC was reported as chronic lymphocitic thyroiditis (benign). An orbitary CT scan showed prominent enlargement of muscle and retroorbitary fat with exophthalmos. The ophthalmologist recommended high-dose corticosteroid pulses, but we were concerned about the risk of hepatitis recurrence. The patient received standard metimazol treatment for hyperthyroidism and bilateral retro-orbital irradiation with a total dose of 10 Gy fractionated in 1 Gy once a week over 10 weeks. After the seventh session, the diplopia remitted and the patient is presently asymptomatic.

Conclusions: Retroorbitary radiotherapy should be considered as an alternative treatment for Graves’-like ophthalmopathy associated to interferon treatment, avoiding the need for high-dose corticosteroids which may result in hepatitis recurrence.