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From the Departments of Internal Medicine (Drs. Monzani, Caraccio, Casolaro, and Ferrannini) and Neuroscience (Drs. Lombardo, Moscato, Murri, and Meducci), University of Pisa School of Medicine, Italy.
Address correspondence and reprint requests to Fabio Monzani, MD, Department of Internal Medicine, University of Pisa, via Roma 67, I-56126 Pisa, Italy
BACKGROUND: The authors previously reported on the development of thyroid dysfunction and autoimmunity during 1-year treatment of patients with MS with interferon-ß1b (IFNß-1b).
OBJECTIVE: To evaluate the evolution of incident thyroid disease and the possible development of more thyroid disease during longer term therapy. Patients:— The authors studied 31 patients (aged 34 ± 7 years; 21 women) with relapsing-remitting MS during 3 years of IFNß-1b treatment. Systematic thyroid assessment was performed every 3 or 6 months, depending on the development of thyroid disease.
RESULTS: After the first year of IFNß-1b treatment, no further cases of thyroid disease were observed. Among the six patients with early incident subclinical hypothyroidism, thyroid dysfunction persisted only in those with baseline autoimmune thyroiditis (n = 2). The three patients who developed transient hyperthyroidism remained euthyroid throughout the treatment course. A positive autoantibody titer was continually detected in only two out of five patients without baseline autoimmunity.
CONCLUSIONS: The risk of thyroid disease seems related to IFNß-1b treatment during the first year only, particularly in patients with preexisting thyroiditis. Furthermore, incident thyroid dysfunction is generally transient and mild in degree. Indeed, we recommend a routine systematic thyroid assessment only in patients with baseline thyroiditis. During the first year of therapy, serum thyroid-stimulating hormone measurement should suffice as first line test; a systematic thyroid assessment is only useful for those patients with incidental and persistent dysfunction. Further studies with many patients will be necessary to confirm our suggestions as broad clinical guidelines.
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