Oral Abstract Abstract

(Adults - Thyroid), #220530541495

A Case of Hashimoto Thyroiditis in a Patient with Hepatitis C: The Effect of DAA (Direct-Acting Antiviral)

Hazwani Ismail, Hospital Pengajar UPM; Ng Oooi Chuan, Hospital Pengajar UPM

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Introduction

The first discovery of an HCV (Hepatitis C Virus) association was found in mixed cryoglobulinemia. Multiple organs and systems were then affected including thyroid. HCV may interfere with the functions and mechanisms of self-recognition of both the immune system and thyroid cells and may directly destroy thyroid tissue or mimic the structure of some components of the thyroid gland, thereby initiating autoimmune disease. Interferon was the old drug for treating HCV, and studies have shown that IFN-induced thyroid autoimmunity can cause both hyperthyroidism and hypothyroidism.

Methods

A 45-year-old Malay male with underlying diabetes mellitus was admitted with difficulty breathing and diagnosed with Hashimoto thyroiditis with positive anti-TPO and anti-thyroglobulin antibodies complicated with pericardial effusion in 2018. His liver enzymes were abnormal and investigations revealed that he had HCV with liver cirrhosis secondary to heroin use in 2018 and subsequently was treated with DAA in 2019. He completed his DAA for 6 months the same year. Repeated investigations showed that he achieved SVR.

Results

After SVR, his thyroxine dosage remained the same which is 1.4mcg/kg/day, ensuring compliance and medication timing. No antibodies were repeated. Otherwise, the development of hypothyroidism did not seem to worsen liver cirrhosis, in terms of upper gastrointestinal bleeding, ascites, or bleeding tendency.

Conclusion

The above case shows that DAA had no impact on thyroid autoimmunity in preexisting Hashimoto Thyroiditis with HCV. Nonetheless, variations in the accuracy of the test techniques and other variables, such as iodine consumption and drugs, contribute to this discrepancy. Patients with HCV infection and autoimmune thyroid disease are influenced by a complex network of cytokines, chemokines, and their receptors. To determine how beneficial these mediators may be as thyroiditis prognostic indicators in the follow-up of HCV+ patients, more research with bigger populations are required.

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