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Interferon--induced hyperthyroidism: a three-stage evolution from silent thyroiditis towards Graves’ disease

¹ Service d’Endocrinologie and ² Service de Gastro-Entéro-Hepatologie, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, avenue du Général Koenig, 51092 Reims, Cedex, France, ³ Service d’Endocrinologie and ⁴ Service d’Hépato-Gastro-Entérologie, Assistance Publique, Hôpitaux de Paris, Centre Hospitalier Universitaire de Bicêtre, France and ⁵ Service d’Endocrinologie-Diabète-Maladies Métaboliques, Centre Hospitalier Universitaire Lyon Sud, Pierre-Bénite, France

(Correspondence should be addressed to B Delemer; Email: bdelemer{at}chureims.fr)

Autoimmune thyroid disease is a common side-effect of interferon- (IFN-) treatment of viral hepatitis C. We have described three patients with hepatitis C for whom IFN- and ribavirin were prescribed and who developed two successive phases of silent thyroiditis followed by hyperthryroidism relapse due to Graves’ disease. These three men had no known history of familial or personal thyroid disease. Destructive thyrotoxicosis appeared 4–6 months after starting IFN-, followed by Graves’ hyperthyroidism within 8 to11 months. The thyrotropin (TSH) level was normal before IFN- was started. The diagnosis of destructive thyroiditis was confirmed by anti-TSH receptor antibody (TSHRAb) negativity and the absence of radionuclide (¹²³I or ⁹⁹Tc) uptake on thyroid scintiscans. Eight to eleven months after starting treatment, TSHRAb positivity and intense scintigraphic uptake confirmed the appearance of Graves’ disease. IFN- was continued in only one patient. Hence, hyperthyroidism induced by IFN- could correspond to the first phase of silent thyroiditis, to Graves’ disease or to the succession of both. Rigorous diagnostic procedures with repeated scintiscans and TSHRAb titering are necessary to avoid a false diagnosis and inappropriate therapy.

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