ABSTRACT
Egypt has the highest prevalence of antibodies to hepatitis C virus [HCV] in the world, estimated nationally at 14.7%. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. Interferon-alpha [IFN-alpha] monotherapy or combined therapy with ribavirin is the cornerstone therapeutic agent for chronic HCV infection. Treatment with IFN may cause thyroid dysfunction. Unfortunately, the clinical approach to this toxic effect is often carried out by personal judgment rather than by defined guidelines. Indeed, clinicians often reduce the dose or sometimes discontinue IFN-alpha treatment in those patients who develop thyroid dysfunction. This may reduce the therapeutic response to this drug. Hence, this study was undertaken to evaluate the impact of INF-alpha monotherapy or combined therapy with ribavirin on thyroid function in chronic HCV adult patients of both sexes in the period from January 2009 to August 2009. Sixty adult chronic HCV patients with normal thyroid function before the start of treatment with IFN-alpha - or IFN-alpha + ribavirin were selected for the study. Of them, 7 patients discontinued treatment, 1 patient died and 5 patients could not be followed during the study period. So the number of patients enrolled in the study after 6 months was 47. Clinical examination for thyroid dysfunction as well as thyroid function tests was then carried out. The study revealed that 17 patients [36.1%] developed abnormal thyroid dysfunction. This risk increased with female gender and in combined therapy with ribavirin. The incidence of hypothyroidism was more than hyperthyroidism particularly, in patients treated with combined therapy. Given the high prevalence of HCV disease in Egypt, it is essential that physicians treating patients with IFN-alpha be aware of the clinical spectrum of thyroid dysfunction, and test for thyroid function prior to starting IFN therapy. Careful thyroid surveillance throughout the treatment period is mandatory, especially in female patients and in those receiving combined therapy with ribavirin. Moreover, patients should be informed of this risk and should be advised to tell their physicians of any related symptoms