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):

  • Extreme fatigue

  • Muscle and joint pain

  • Fever

  • Nausea and stomach pain

  • Poor appetite/anorexia

  • Itchy skin

  • Dark urine

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.

References

  1. Ferri C, et al. HCV-related autoimmune and neoplastic disorders: the HCV syndrome, 2007

  2. Ferrari SM, et al. HCV-related autoimmune disorders in HCV chronic infection, 2013

  3. Antonelli A, et al. Endocrine manifestations of hepatitis C virus infection, 2009

  4. Shen Y, et al. Thyroid disturbance in patients with chronic hepatitis C infection: a systematic review and meta-analysis, 2016

  5. Ferri C, et al. Infection of peripheral blood mononuclear cells by hepatitis C virus in mixed cryoglobulinemia, 1993

  6. Di Domenicantonio A, et al. A review on thyroid autoimmune disorders and HCV chronic infection, 2014

  7. Fallahi P, et al. Autoimmune and neoplastic thyroid diseases associated with hepatitis C chronic infection, 2014

  8. Colaci M, et al. Endocrine disorders associated with hepatitis C virus chronic infection, 2018

  9. D’Souza R. Diagnosis and treatment of hepatitis C, 2004

  10. Courouce A-M, et al. Significance of NS3 and NS5 antigens in screening for HCV antibody, 1994

  11. Lisker-Melman M, et al. Development of thyroid disease during therapy of chronic viral hepatitis with interferon alfa, 1992

  12. Custro N, et al. Prospective study on thyroid autoimmunity and dysfunction related to chronic hepatitis C and interferon therapy, 1997

  13. Wong V, et al. Thyrotoxicosis induced by α-interferon therapy in chronic viral hepatitis, 2002

  14. Indolfi G, et al. Thyroid function and anti-thyroid autoantibodies in untreated children with vertically acquired chronic hepatitis C virus infection, 2008

  15. Tomer Y. Hepatitis C and interferon induced thyroiditis, 2010

  16. 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

  17. 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