Thyroid pathology in the Presence of antiviral treatment of chronic hepatitis C. Professor Nikitin Igor G Russian State Medical University MOSCOW
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1 Thyroid pathology in the Presence of antiviral treatment of chronic hepatitis C Professor Nikitin Igor G Russian State Medical University MOSCOW
2 The structure of the side effects associated with antiviral therapy of chronic hepatitis C Adverse effects associated with the use of ribavirin Adverse effects associated with interferon
3 Therapeutic tactics correction known side effects associated with the therapy of alpha - interferon in patients with chronic hepatitis C Undesirable (adverse) effects, requiring the immediate lifting of alpha interferon - irrespective of the results of treatment of chronic hepatitis C Undesirable (adverse) effects, requiring dose changes or the introduction of the multiplicity of alpha interferon Absolute contraindications to the alpha - interferon
4 Undesirable (adverse) effects, requiring the immediate lifting of alpha interferon - irrespective of the results of treatment of chronic hepatitis C 1. Retinopathy 2. Sarcoidosis 3. Colitis 4. Hyperglycemia or manifest diabetes mellitus 5. Interstitial lung disorders 6. A considerable hearing loss 7. Progressing depression with suicidal
5 Undesirable (adverse) effects, requiring dose changes or the introduction of the multiplicity of alpha interferon - Changes in peripheral blood (neutropenia, thrombocytopenia) Dermatological manifestations (reaction at the injection site, rash, pruritis) Dysfunction of thyroid gland Neuropsychiatric symptoms (sleep disturbance, reduced concentration, irritability or aggressiveness, depression) Flu-like syndrome (myalgia, fever, weakness, fatigue)
6 Prospectively mechanisms damage the thyroid gland under the influence of alpha - interferon Violation ratio of CD4/CD8 Alpha interferon Hereditary predisposition of HLA - B8, DR3, DR4 Production of B - lymphocytes LATS - protein Stimulation of the TSH receptor Production blocking antibodies atpo, atsh Graves' disease Autoimmune thyroiditis Destructive thyroiditis
7 Methods for evaluation of patients with thyroid disorders 4. Workup 5. Evaluation of the thyrotropic and thyroid hormones (free fraction) 6. Color Doppler mapping of the thyroid gland 7. Immunological study: antithyroid antibodies, thyroidstimulating protein, antibodies to the receptor thyroglobulin
8 Ultrasound investigation of the thyroid gland The normal pattern of cross-scanning of the thyroid gland
9 Ultrasound investigation of the thyroid gland Increasing the area of vascularization of the parenchyma> 0.65 rel. Ed.
10 Color Doppler mapping of the thyroid gland Study of peak and volumetric blood flow velocity in a. thyreoidea superior
11 Ultrasound investigation of the thyroid gland Nodal hypertrophic form of autoimmune thyroiditis
12 Color Doppler mapping of the thyroid gland The center of lymphoid infiltration in the nodal form of autoimmune thyroiditis - a phenomenon of the lack of vascularization in the center
13 The tactics of management of patients with the development of interferon - induced damage to the thyroid gland Damage type Hormonal Treatment Relation to profile antiviral treatment Hypothyroidism ТSH > N L- T4 Continuation treatment atpo>n; atsh>n Destructive thyrotoxicosis TSH < N; ft3>n ft4>n; LATS<N -no symptoms treatment is not Continuation treatment required -There are symptoms β -blockers Continuation treatment - hyperthyroidism under the control of the situation The situation is not controlled - cancel interferon treatment
14 The tactics of management of patients with the development of interferon - induced damage to the thyroid gland Damage type Hormonal Treatment Relation to profile antiviral treatment Graves' disease TSH<N; ft4>n ft3>n; LATS>N atshr>n -mild course of disease Thyreostatics Continuation - pronounced symtoms of thyreotoxicosis Preferably propithy hyouracile Radioiodine therapy treatment Cancel treatment
15 Conclusion Lesions of the thyroid gland against the background of antiviral therapy in patients with chronic hepatitis C is very heterogeneous. Careful examination of thyroid function in patients with chronic hepatitis C as at the start of therapy, and in the process of its implementation. The decision on the future conduct of antiviral therapy in patients with chronic hepatitis C is solved in each case individually (weighed the feasibility and success of antiviral treatment and possible complications associated with dysfunction of the thyroid gland)
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Guidance for Thyroid Function Testing in Primary Care in Lothian In July 2006 following a lengthy consultation process, a joint working group comprising representatives from the Association of Clinical
PLEGRIDY (peginterferon beta-1a) injection, for subcutaneous injection Initial U.S. Approval: 2014
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use PLEGRIDY safely and effectively. See full prescribing information for PLEGRIDY. PLEGRIDY (peginterferon