インターフェロン治療中止にもかかわらずバセドウ病を発症した一例

概要

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Interferon (IFN)-α has been reported to have several adverse effects including thyroid dysfunction. We herein report a case of Graves' disease that developed after withdrawal of PEG-INF-α therapy. The patient was a 62-year-old woman who was admitted to our department for radioactive iodine therapy (RIT) for Graves' disease. Eleven years earlier, when the diagnosis of chronic hepatitis C had been confirmed, PEG-INF therapy with ribavirin was initiated, but therapy was withdrawn after three months because of severe cough and thrombocytopenia (platelets < 70,000/mm^3). She developed palpitations soon after withdrawal of therapy, and pitting edema was evident after 2 months. At that time her thyroid hormone levels were elevated and Graves' disease was diagnosed. Thiamazole was initiated, but this was changed to propyluracil (PTU) because of liver dysfunction. However, PTU did not ameliorate the thyrotoxicosis. Therefore, RIT was performed after admission to our department. Recent studies have demonstrated that IFN induces thyroid dysfunction in 15% of patients with hepatitis C. Female gender, a family history of thyroid disease, presence of thyroid autoantibodies, and HCV infection are risk factors for thyroid dysfunction. In the present case, we have no data about thyroid autoantibodies such as TRAb or TSAb before IFN therapy, but this therapy may have exacerbated subclinical Graves' disease in this patient.
東京女子医科大学の論文