Interferon-α induced thyroid dysfunction:: Three clinical presentations and a review of the literature
Interferon-α induced thyroid dysfunction:: Three clinical presentations and a review of the literature
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DOI：
10.1089/thy.1997.7.891
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发表时间：
1997-12-01
期刊：
影响因子：
6.6
通讯作者：
Yeo, PPB
中科院分区：
文献类型：
--
作者：
Koh, LKH;Greenspan, FS;Yeo, PPB
三名患者谁开发的症状，自身免疫介导的甲状腺功能障碍的治疗过程中与干扰素-α（IFN-α）的慢性活动性丙型肝炎肝硬化，年龄相关性黄斑变性与黄斑中心凹参与，慢性髓细胞性白血病，分别进行了描述。前两名患者发展自身免疫性甲状腺功能减退症，需要甲状腺素替代，第三个发展自身免疫性甲状腺炎与短暂性甲状腺毒症。临床表现多变，需要高度怀疑诊断，诊断失败会导致严重的发病率。文献综述显示，IFN-α诱导的甲状腺功能障碍的平均发生率为6%。超过一半的患者在中断IFN-α治疗后自发消退。甲状腺功能减退症的诱发率高于甲状腺功能亢进症。至少有一个阳性甲状腺自身抗体滴度在17%的患者接受IFN-α。IFN-α治疗后发生甲状腺功能障碍的危险因素包括女性、潜在的恶性肿瘤或丙型肝炎、IFN-α剂量更高、持续时间更长、联合免疫治疗（特别是与白细胞介素-2）以及治疗前或治疗期间存在甲状腺自身抗体。
Three patients who developed symptomatic, autoimmune-mediated thyroid dysfunction during treatment with interferon-alpha (IFN-alpha) for chronic active hepatitis C with liver cirrhosis, age-related macular degeneration with foveal involvement, and chronic myelogenous leukemia, respectively, are described. The first two patients developed autoimmune hypothyroidism that required thyroxine replacement, and the third developed autoimmune thyroiditis with transient thyrotoxicosis. The clinical manifestations were protean, and required a high index of suspicion for diagnosis, the failure of which led to significant morbidity. A literature review revealed that the mean incidence of IFN-alpha induced thyroid dysfunction was 6%. Spontaneous resolution occurred in more than half with discontinuation of IFN-alpha treatment. Hypothyroidism was induced more frequently than hyperthyroidism. At least one positive thyroid autoantibody titer was found in 17% of patients receiving IFN-alpha. Risk factors for developing thyroid dysfunction with IFN-alpha treatment were female sex, underlying malignancy or hepatitis C, higher doses of IFN-alpha for longer durations, combination immunotherapy (especially with interleukin-2), and the presence of thyroid autoantibodies prior to or during treatment.