对干扰素相关性甲状腺疾病的浅识

1、深圳市人民医院内分泌科 李路r. malik and h. hodgson. the relationship between the thyroid gland and the liver. q j med 2002; 95:559569（-）（-）中国甲状腺疾病诊治指南（2008年版）jamie c. mandac,et al. the clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. hepatology 2006;43:661

2、-672.c. carella, et al. interferon-related thyroid disease:pathophysiological, epidemiological, and clinical aspects. the journal of clinical endocrinology & metabolism.2004; 89(8):36563661. tsh t3t4甲减tab自身免疫性甲减桥本氏病非自身免疫性甲减+-多为持续性疾病一过性/持续性tsh t3t4甲状腺毒症甲状腺摄碘率升高trab+低平grave病破坏性甲毒症+jamie c. mandac,

3、et al. the clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. hepatology 2006;43:661-672.f. monzani, et al. thyroid autoimmunity and dysfunction associated with type i interferon therapy. clin exp med. 2004; 3:199210.疾病疾病患者患者甲状腺功能减退症甲状腺功能减退症甲状腺毒

4、症甲状腺毒症合计合计乙肝乙肝丙肝丙肝恶性肿瘤恶性肿瘤多发性硬化多发性硬化合计合计f. monzani, et al. thyroid autoimmunity and dysfunction associated with type i interferon therapy. clin exp med. 2004; 3:199210.甲状腺功能异常一过性持续性甲状腺功能减退症56(51.9%)52(48.1%)n=108 62.1%甲状腺毒症45(68.2%)21(31.8%)n=66 37.9%o. dalgard, et al. thyroid dysfunction during tre

5、atment of chronic hepatitis c with interferon alpha: no association with either interferon dosage or efficacy of therapy. journal of internal medicine 2002; 251: 400406.所有患者所有患者 甲状腺功能异常甲状腺功能异常无甲状腺功能异常无甲状腺功能异常干扰素诱导治疗干扰素诱导治疗 n(%)干扰素剂量干扰素剂量/体重体重 平均平均(miu kg-1)治疗结束时治疗结束时hcv转阴转阴(n(%)治疗结束后治疗结束后6个月个月hcv转阴转

6、阴(n(%)女性女性f. monzani, et al. thyroid autoimmunity and dysfunction associated with type i interferon therapy. clin exp med. 2004; 3:199210.koh lk, et al. interferon-alpha induced thyroid dysfunction: three clinical presentations and a review of the literature. thyroid. 1997 dec;7(6):891-6. 性别患者甲状腺功能减

7、退症甲状腺毒症总计男性63120（3.2）7（1.1）27（4.3）女性41237（9.0）19（4.6）56（13.6）总计104357（5.5）26（2.5）83（8.0）j-f. huang, et al. the role of thyroid autoantibodies in the development of thyroid dysfunction in taiwanese chronic hepatitis c patients with interferon-alpha and ribavirin combination therapy. journal of viral

8、hepatitis, 2006, 13, 396401gene-enviroment interaction-mechanismsluisa fernandez-soto, et al. increased risk of autoimmune thyroid disease in hepatitis c vs hepatitis b before, during, and after discontinuing interferon therapy. arch intern med. 1998;158:1445-1448. 丙肝患者较乙肝甲状腺自身抗体滴度更高41例134例f. monzan

9、i, et al. thyroid autoimmunity and dysfunction associated with type i interferon therapy. clin exp med. 2004; 3:199210. 甲状腺自身抗体阳性者 在干扰素治疗后更易发生甲状腺功能异常基线时甲状腺基线时甲状腺自身抗体自身抗体发生甲状腺发生甲状腺功能异常功能异常未发生甲状腺未发生甲状腺功能异常功能异常阳性阳性阴性阴性luisa fernandez-soto, et al. increased risk of autoimmune thyroid disease in hepatiti

10、s c vs hepatitis b before, during, and after discontinuing interferon therapy. arch intern med. 1998;158:1445-1448. 参数未发生甲状腺未发生甲状腺功能异常功能异常发生甲状腺发生甲状腺功能异常功能异常jamie c. mandac,et al. the clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. hepatology

11、2006;43:661-672.病毒性肝炎患者尤其是高危人群，干扰素治疗前病毒性肝炎患者尤其是高危人群，干扰素治疗前检测检测tsh和甲状腺自身抗体和甲状腺自身抗体(tab)tsh正常且正常且tab阴性阴性tsh正常而正常而tab阳性阳性tsh异常而异常而tab+/-每每三个月三个月随访一次随访一次tsh直至干扰素治疗结束直至干扰素治疗结束干扰素治疗结束时检测干扰素治疗结束时检测tsh和和tab如出现异常，处理见后如出现异常，处理见后每每两个月两个月随访一次随访一次tsh直至干扰素治疗结束直至干扰素治疗结束干扰素治疗结束时检测干扰素治疗结束时检测tsh和和tab如出现异常，处理见后如出现异常，处

12、理见后进一步明确甲状腺进一步明确甲状腺功能异常的种类功能异常的种类处理见后处理见后sato k, et al. reversible, extremely severe hypothyroidism in a patient with chronic hepatitis c treated with interferon-alpha. thyroid. 1996 jun;6(3):249-52. carlo carella, et al. long-term outcome of interferon-a-induced thyroid autoimmunity and prognostic

13、influence of thyroid autoantibody pattern at the end of treatment. j clin endocrinol metab 86: 19251929, 2001.甲状腺功能减退症患者甲状腺功能减退症患者检测甲状腺自身抗体检测甲状腺自身抗体阴性阴性阳性阳性甲状腺素短期治疗甲状腺素短期治疗继续干扰素治疗继续干扰素治疗甲状腺素长期治疗甲状腺素长期治疗继续干扰素治疗继续干扰素治疗？破坏性甲状腺毒症患者破坏性甲状腺毒症患者无症状无症状有症状有症状无需针对性治疗无需针对性治疗继续干扰素治疗继续干扰素治疗加用加用受体受体阻滞剂治疗阻滞剂治疗症状控制症

14、状控制继续继续受体受体阻滞剂治疗阻滞剂治疗继续干扰素治疗继续干扰素治疗停止干扰素停止干扰素治疗直治疗直至甲状腺功能恢复正常至甲状腺功能恢复正常c. carella, et al. interferon-related thyroid disease:pathophysiological, epidemiological, and clinical aspects. the journal of clinical endocrinology & metabolism.2004; 89(8):36563661.症状不能控制症状不能控制grave病病患者患者病情较轻病情较轻病情严重病情严重抗

15、甲状腺药物治疗抗甲状腺药物治疗继续干扰素治疗继续干扰素治疗放射碘治疗？放射碘治疗？停止干扰素治疗停止干扰素治疗直至甲状腺功能恢复正常直至甲状腺功能恢复正常c. carella, et al. interferon-related thyroid disease:pathophysiological, epidemiological, and clinical aspects. the journal of clinical endocrinology & metabolism.2004; 89(8):36563661.mark f. prummel and peter laurberg

16、, et al. interferon-a and autoimmune thyroid disease. thyroid. 2003; 13 (6):547-551.诊断？carlo carella, et al. long-term outcome of interferon-a-induced thyroid autoimmunity and prognostic influence of thyroid autoantibody pattern at the end of treatment. j clin endocrinol metab 86: 19251929, 2001.治疗结

17、束时甲状腺自身抗体阳性是发生甲状腺功能异常的独立预测因素治疗结束时甲状腺自身抗体阳性是发生甲状腺功能异常的独立预测因素观察时间c. carella, et al. interferon-related thyroid disease:pathophysiological, epidemiological, and clinical aspects. the journal of clinical endocrinology & metabolism.2004; 89(8):36563661.melanie deutsch,et al. thyroid abnormalities in chronic viral hepatitis and their relationship to interferon alfa therapy. hepatology 1997;26:206-210r. malik and h. hodgson. the relationship between the thyroid gland and the liver. q j med 2002; 95:559569.c. carella, et al. interferon-related thyroid disease:pa