Journal of Autoimmunity (2000) 14, 189–193doi: 10.1006/jaut.1999.0360, available online at http://www.idealibrary.com on
Latent Autoimmune Thyroiditis in Untreated Patients with
HCV Chronic Hepatitis: a Case-control Study
Nathalie Ganne-Carrie
1
, Abdelkrim Medini
1
, Emmanuelle Coderc
2
, Olivier Seror
2
,
Christos Christidis
1
, Sylvie Grimbert, Jean-Claude Trinchet
1
and Michel Beaugrand
1
1
Department of
1
Hepato-gastroenterology
and
2
Radiology, Hospital Jean Verdier
93140 Bondy, France
Received: 12 March 1999
Accepted: 26 November 1999
In order to establish a relationship between Hepatitis C virus (HCV) chronic
infection and autoimmune thyroiditis, 97 untreated patients with biopsy-
proven HCV chronic hepatitis and 97 controls were studied. An ultrasound
examination of the thyroid and an assay of serum thyroid-stimulating hor-
mone (TSH), thyroid hormones and anti-thyroid antibodies were performed in
all cases. The overall prevalence of thyroid abnormalities was higher in
patients than in controls (17 vs. 4%, P<0.01) and the prevalence of anti-thyroid
antibodies was significantly different between the two groups (P<0.02). HCV
patients with (n=13) compared to HCV patients without anti-thyroid anti-
bodies (n=84) were older, predominantly female, and more frequently had
increased serum TSH levels or a hypoechogenic pattern of the thyroid gland,
while Knodell’s score and prevalence of cirrhosis were similar. Latent auto-
immune thyroiditis is more frequent in untreated HCV patients than in
controls. This finding raises questions about the mechanism of autoimmunity
induced by HCV and provides an explanation for the high rate of overt
autoimmune thyroiditis during interferon treatment in these patients.
© 2000 Academic Press
Key words: hepatitis C virus,
autoimmune thyroiditis, thyroid
ultrasonography, anti-thyroid
antibodies, alpha-interferon
Introduction
Hepatitis C virus (HCV) infection is commonly associ-
ated with the presence of organ-specific or non-
specific autoantibodies and a high prevalence of
immunological disorders such as cryogulinemia and
Sjogren’s syndrome [1–7]. Several observations sug-
gest a potential relationship between HCV infection
and autoimmune thyroiditis (AT). A high prevalence
of anti-thyroid antibodies has been observed in
patients with chronic hepatitis C prior to any inter-
feron treatment, especially a high prevalence of anti-
microsomal or anti-thyroperoxidase antibodies [8, 9].
Similarly, a high prevalence of anti-HCV antibodies in
patients with anti-thyroid antibodies and in patients
with AT has been reported [10], although not con-
firmed by other authors [11–13]. Lastly, a high inci-
dence of thyroid dysfunction related in most cases to
AT has been observed during alpha-interferon (INF)
treatment in patients with chronic hepatitis C [2, 9].
Although not statistically different, the occurrence of
dysthyroidism during alpha-interferon treatment
seems higher in patients with chronic hepatitis C than
in patients with chronic hepatitis B treated by higher
doses [14]. As a whole, the responsibility of HCV in
AT remains undemonstrated.
An abnormal ultrasound pattern of the thyroid,
characterized by diffuse low echogenicity, has been
reported in autoimmune thyroid diseases, and its
potential value in the diagnosis of AT has been
emphasized [15, 16]. In addition to antithyroid
antibodies, the ultrasound pattern could help to
identify patients with AT who are prone to develop
hypothyroidism [17].
This study was designed to assess the prevalence of
both laboratory and ultrasound abnormalities sug-
gestive of AT in untreated patients with chronic
hepatitis C and in controls matched for sex, age and
the presence of cirrhosis.
Patients and Methods
Patients
Ninety-seven consecutive untreated patients with
biopsy proven chronic hepatitis C who had been
hospitalized for more than 1 day were included in the
study (group A). They were compared to 97 control
patients hospitalized during the same period in the
same unit and matched for sex, age and the presence
Correspondence to: Nathalie Ganne-Carrie, Service d’He´pato-
Gastroente´rologie, Hoˆpital Jean Verdier, Avenue du 14 juillet,
F-93143 Bondy Cedex, France. Fax: 01–48–02–62–02. E-mail:
nathalie.ganne@jvr.ap-hop-paris.fr
189
0896–8411/00/020189+05 $35.00/0 © 2000 Academic Press