How hepatitis C infection triggers Hashimoto’s and leads to an underactive thyroid
Chronic hepatitis C infection causes chronic inflammation and thyroid damage
Hepatitis C virus (HCV) infection is more than a condition affecting the liver, it is a chronic inflammatory disease — triggering autoimmune response and organ damage. It can affect multiple organs, including the thyroid gland (1–4).
HCV has an affinity to attack not only the liver cells, hepatocytes, but also the immune cells, B lymphocytes — this is the way in which it’s able to trigger the autoimmune response (5).
Hepatitis C virus and Hashimoto’s
Hashimoto’s is the most frequent autoimmune disorder associated with HCV infection (6), leading to the rise in both thyroid antibodies (anti-TPO and anti-TG) as well as TSH (4).
Thyroid cells get infected by HCV and as a consequence, thyroid cells start producing molecules that support ongoing inflammation and thyroid damage (7). This inflammation might be very subtle at the start and can take a long time — even months — before the first signs of the thyroid problem occur (8).
Symptoms of hepatitis C virus infection
It usually takes about seven weeks to start showing symptoms, and symptoms may last anytime between two and 12 weeks (9):
Muscle and joint pain
Nausea and stomach pain
Hepatitis C is diagnosed through a blood test, and in some cases a liver biopsy (10).
Hepatitis C treatment
There are a few standard treatments, taking direct acting antiviral (DAA) pills for 8–12 weeks, after which your blood will be re-checked for the presence of the virus.
Interferon-α treatment of HCV can cause thyroid damage and an underactive thyroid by triggering Hashimoto’s-like disease in people with genetic predisposition to develop thyroid conditions (11–15), increasing anti-TPO and anti-TG antibodies (16). In some cases, antibody levels can drop down after the completion of interferon therapy (12, 17).
Talking to your doctor
If you are diagnosed with HCV, it may be good to mention to your health care provider that you have a thyroid condition, or a familiar history of thyroid conditions — this may help them to design the best treatment option for you.
It is also good to track symptoms that overlap between hepatitis C and an underactive thyroid, such as: fatigue, muscle pain, and changes in body temperature.
Knowing how your symptoms look throughout a long period of time can be helpful information for your doctor in determining how successful your therapy is.
Ferri C, et al. HCV-related autoimmune and neoplastic disorders: the HCV syndrome, 2007
Ferrari SM, et al. HCV-related autoimmune disorders in HCV chronic infection, 2013
Antonelli A, et al. Endocrine manifestations of hepatitis C virus infection, 2009
Shen Y, et al. Thyroid disturbance in patients with chronic hepatitis C infection: a systematic review and meta-analysis, 2016
Ferri C, et al. Infection of peripheral blood mononuclear cells by hepatitis C virus in mixed cryoglobulinemia, 1993
Di Domenicantonio A, et al. A review on thyroid autoimmune disorders and HCV chronic infection, 2014
Fallahi P, et al. Autoimmune and neoplastic thyroid diseases associated with hepatitis C chronic infection, 2014
Colaci M, et al. Endocrine disorders associated with hepatitis C virus chronic infection, 2018
D’Souza R. Diagnosis and treatment of hepatitis C, 2004
Courouce A-M, et al. Significance of NS3 and NS5 antigens in screening for HCV antibody, 1994
Lisker-Melman M, et al. Development of thyroid disease during therapy of chronic viral hepatitis with interferon alfa, 1992
Custro N, et al. Prospective study on thyroid autoimmunity and dysfunction related to chronic hepatitis C and interferon therapy, 1997
Wong V, et al. Thyrotoxicosis induced by α-interferon therapy in chronic viral hepatitis, 2002
Indolfi G, et al. Thyroid function and anti-thyroid autoantibodies in untreated children with vertically acquired chronic hepatitis C virus infection, 2008
Tomer Y. Hepatitis C and interferon induced thyroiditis, 2010
Nagayama Y, et al. Exacerbation of thyroid autoimmunity by interferon alpha treatment in patients with chronic viral hepatitis: our studies and review of the literature, 1994
Carella C, et al. Long-term outcome of interferon-α-induced thyroid autoimmunity and prognostic influence of thyroid autoantibody pattern at the end of treatment, 2001
Collage made from HCV by BruceBlaus