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Extrahepatic Manifestations of Chronic Hepatitis C
Does Hepatitis C Affect My Whole Body?
Source @ Thyroid Wellness Letter
Well conducted research has shown that Hepatitis C virus infection can also promote
immune attacks on the thyroid. The research has shown that both thyroid imbalance
and thyroid anti-bodies are much more common in patients with Hepatitis C virus
infection than in normal people. In fact, nearly 10% of patients with Hepatitis C have a
thyroid disorder and positive thyroid anti-bodies.
The reason is that the Hepatitis C virus shares some molecular similarities with the
thyroid and this may make the immune system mistakenly attack the thyroid gland in
response to the presence of foreign molecules coming from the virus. The virus could
also be infecting the thyroid cells and that could trigger the attack of the immune
system on the thyroid gland.
Alfa-interferon is a medication widely used to treat infections and cancer. This
medication is also used to treat chronic Hepatitis C. It also happens that the
medication Interferon can also trigger an auto-immune thyroid disease. So patients
with Hepatitis C virus who are already pre-disposed to having an auto immune thyroid
disease and are taking Alpha-Interferon are at higher risk of having an auto-immune
thyroid condition.
It has been estimated that thyroid disorders may occur in as many as 20-40% and a
significant thyroiditis may occur in 5-10% of patients treated with Alpha-Interferon.
Interferon can cause both Hashimoto’s Thyroiditis and Graves Disease. If a person has
positive anti-thyroid antibody prior to being treated with interferon, the risk of having
a significant thyroiditis becomes quite high.
Interferon treatment can even trigger an auto-immune thyroiditis in people without
thyroid anti-bodies. So if one has a genetic vulnerability to auto-immune thyroid
disease, the use of interferon therapy makes the likelihood of having an auto-immune
thyroid condition become more significant. Interferon can also cause a thyroiditis not
mediated by the immune system but instead by a destruction of thyroid cells. This
medication can directly destroy thyroid cells and makes thyroid hormone pour in our
system. This ends up causing hyperthyroidism. Often the hyperthyroidism is followed
by hypothyroidism as in Silent Thyroiditis. This is interpreted as a direct toxic effect of
the medication.
Thyroid Disease: Dr. Val Jones
Thyroid disorders common in patients with chronic hepatitis C
By Will Boggs, MD
NEW YORK (Reuters Health) - Chronic infection with hepatitis C virus (HCV) is associated with an
increased rate of hypothyroidism and thyroid autoimmunity, according to a report in the July 1st
issue of The American Journal of Medicine.
"The significant association of chronic hepatitis C with hypothyroidism and thyroid autoimmune
phenomena implies that these patients should be screened for thyroid function on a periodic
basis," lead author Dr. Alessandro Antonelli from the University of Pisa School of Medicine, Italy,
told Reuters Health. "A substantial proportion-13% in our series-will have hypothyroidism, and
thus might benefit from treatment."
Thyroid involvement in HCV-infected patients has been reported previously, the authors explain,
but little is known about the prevalence and nature of thyroid disorders in such patients.
Dr. Antonelli and colleagues investigated the prevalence and features of thyroid disorders in 630
consecutive patients with chronic hepatitis due to HCV infection.
Patients with chronic HCV infection had significantly higher thyroid stimulating hormone (TSH) and
significantly lower free T3 and free T4 levels than did uninfected controls or hepatitis B virusinfected patients, the authors report.
Significantly more HCV-infected patients than controls had positive anti-thyroid peroxidase or antithyroglobulin autoantibodies, the results indicate, and hypothyroidism (TSH greater than 4
mIUnits/mL) was significantly more common among HCV-infected patients (13%) than among
controls (3-5%).
Both markers of autoimmunity were more common in hypothyroid HCV-infected patients than in
euthyroid HCV-infected patients, the researchers note.
"We are planning a population based epidemiological study to assess the association between
thyroid disorders and HCV infection," Dr. Antonelli added. "The possible association of HCV
infection with thyroid differentiated cancer and diabetes mellitus is under investigation not only in
patients with HCV infection, but also in patients with HCV associated mixed cryoglobulinemia."
Am J Med 2004;117:10-13,60-61.
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Thyroid Disorders Common with Hepatitis C
www.natap.org
Researchers report that people with chronic hepatitis C virus (HCV) infection are at a significantly higher risk
of having thyroid disorders. The study authors recommend that HCV patients should be periodically screened
for thyroid function, in particular hypothyroidism, which affected 13 percent of the HCV patients in this
study. HCV-infected patients also had higher ratesof being positive for anti-thyroid autoantibodies, an early
indicator of autoimmune thyroid disease. (SOURCE: American Journal of Medicine, July 1, 2004.)
http://www.thyroidresearchjournal.com/content/2/1/12
http://hepatitiscnewdrugs.blogspot.com/2010/11/thyroid-and-hepatitis-c.html
Cryoglobulinemia is a medical condition in which the blood contains large amounts of
cryoglobulins - proteins that become insoluble at reduced temperatures. Cryoglobulins typically
precipitate at temperatures below normal body temperature (37 degrees Celsius) and will
dissolve again if the blood is heated. Cryoglobulinemia can be associated with various diseases
such as multiple myeloma and hepatitis C infection.
Classification
Cryoglobulinemia is classically grouped into three types according to the Brouet classification.
Type I is most commonly encountered in patients with a plasma cell dyscrasia such as multiple
myeloma or Waldenström macroglobulinemia. Types II and III are strongly associated with
infection by the hepatitis C virus.
There are three different types of cryoglobulins that have been observed to form in the blood.
What conditions outside the liver are associated with hepatitis C infection?
Most of the signs and symptoms of HCV infection relate to the liver. Less commonly, HCV infection causes conditions
outside of the liver.

HCV infection can cause the body to produce unusual antibodies called 'cryoglobulins'. These cryoglobulins
cause inflammation of the arteries (vasculitis) which may damage the skin, joints, and kidneys. Patients with
cryoglobulinemia (cryoglobulins in the blood) may have joint pain, arthritis, a raised purple rash on the legs,
generalized pain or swelling. In addition, these patients may develop Raynaud's phenomenon in which the
fingers and toes turn color (white, then purple, then red) and become painful at cold temperatures.

Two skin conditions, lichen planus and porphyria cutanea tarda, have been associated with chronic infection
with HCV.

For reasons that are unclear, diabetes is three times more common among patients with chronic HCV
infection than in the general population.

Low platelet counts may occur as a result of the destruction of platelets by antibodies.

HCV also is associated with B-cell lymphoma, a cancer of the lymph system.
Curr Opin Rheumatol. 2008 Jan;20(1):23-8.
Treatment of hepatitis C-associated mixed cryoglobulinemia vasculitis.
Saadoun D, Delluc A, Piette JC, Cacoub P.
Source
Université Pierre et Marie Curie-Paris, Paris, France and Hôpital Pitié-Salpêtrière, Service de Médecine Interne,
Paris, France.
Abstract
PURPOSE OF REVIEW:
Hepatitis C virus infection is the main cause of mixed cryoglobulinemia vasculitis. The disease expression of mixed
cryoglobulinemia vasculitis is variable, ranging from mild clinical symptoms (purpura, arthralgia) to fulminant lifethreatening complications (glomerulonephritis, widespread vasculitis). Treatment of hepatitis C virus-mixed
cryoglobulinemia vasculitis may target either the viral trigger (hepatitis C virus) or the downstream B-cell arm of
autoimmunity. This review focuses on recent advances in our understanding of the treatment of hepatitis C virusmixed cryoglobulinemia vasculitis.
RECENT FINDINGS:
Aggressive antiviral therapy with Peg-IFNalpha and ribavirin should be considered as induction therapy for hepatitis C
virus-mixed cryoglobulinemia vasculitis with mild to moderate disease severity and activity. In patients presenting with
severe disease, an induction phase of immunosuppression is often necessary while awaiting the generally slow
response to antiviral treatments. Combination therapy with rituximab and Peg-IFNalpha plus ribavirin appears logical
as it may target both the viral trigger (hepatitis C virus) and cryoglobulin-producing B-cells.
SUMMARY:
Antiviral therapy and rituximab are the main therapeutic options in hepatitis C virus-mixed cryoglobulinemia vasculitis.
Further studies are needed to better define the therapeutic strategy.
PMID:
18281853
[PubMed - indexed for MEDLINE]
How You Can Stop HCV from Leading to Gallstones
February 26, 2007
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Recent research has shown how Hepatitis C patients have a greater tendency to develop
gallstones. Learn how to prevent your diagnosis from leading to one of the 1 million new cases
of gallstones reported each year.
by Nicole Culter, L.Ac.
Gallstone disease is the most common disorder affecting the body's biliary system, the network
of organs and ducts responsible for creating, transporting, storing and releasing bile.
Responsible for the digestion of fat, bile is a fluid produced by the liver and stored in the
gallbladder. Bile primarily consists of water, cholesterol, fats, bile salts, proteins and bilirubin. If
the chemical balance of bile contains too much of any of these components, particularly
cholesterol, crystals form and harden into gallstones.
Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can
develop just one large stone, hundreds of tiny stones, or anywhere in between. When gallstones
lodge in bile ducts, they can prevent the flow of bile or digestive enzymes or lead to severe
abdominal pain, vomiting, inflammation and possible infection.
Symptoms
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. A
typical attack can cause:
· Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several
hours
· Pain in the back between the shoulder blades
· Pain under the right shoulder
· Nausea or vomiting
Gallstone attacks often follow fatty meals, and they may occur during the night. Other gallstone
symptoms include:
1. Abdominal bloating
2. Recurring intolerance of fatty foods
3. Belching
4. Gas
5. Indigestion
The Link Between Hepatitis C and Gallstones
Over the years, the medical community has suspected a connection between liver disease and
gallbladder disease. Researchers looking to prove this suspicion have shown how people with
Hepatitis C have a greater tendency to develop gallstones.
· An Italian study published in the Archives of Internal Medicine in 1999 suggested that cirrhosis
represents a major risk factor for gallstones.
· A New York study published in the May 2005 issue of Hepatology concluded that chronic
Hepatitis C infection demonstrated a strong association with gallbladder disease and that
gallbladder disease was more common in adults with severe liver disease.
· Published in the September 2005 issue of Journal of Gastroenterology and Hepatology, a
Taiwanese study involving nearly 30,000 people confirmed that infection with Hepatitis C
contributes to gallstone formation.
How This Impacts People with Hepatitis C
Considering the clinical proof that people with chronic Hepatitis C are at a greater risk for
developing gallbladder disease, those harboring this virus are strongly encouraged to practice
gallstone prevention.
Diet modification is the primary method to prevent gallstones from developing. Increasing
consumption of both soluble and insoluble fiber may prevent gallstones. Fiber reduces the
absorption of deoxycholic acid by producing a favorable shift in the triad of factors controlling
cholesterol's solubility in bile. Soluble fibers that are effective include guar gum and pectin, as
well as oat bran, wheat bran, and soy fiber, all of which are found in many fruits and vegetables.
Additionally, regular, vigorous, exercise may decrease gallstone risk. One study, reported by
WebMD, found that men who performed endurance activities for 30 minutes, five times a week,
experienced a 34 percent reduction in gallbladder disease risk. The benefits derived from
exercise were more dependent on intensity than type of exercise. Researchers theorize that
exercise helps to normalize blood sugar and insulin levels which may contribute to gallstones
when abnormal.
Evidence gathered on gallstone formation clearly points to an increased risk for individuals with
the Hepatitis C virus. While people with chronic Hepatitis C likely have plenty of other health
concerns, practicing gallstone prevention is easy due to its similarity to liver supportive lifestyle
changes. Now there is one more reason for those with liver disease to incorporate healthful
habits by increasing the fiber in their diet and getting started on a regular exercise routine.
References
Posted by Editors at February 26, 2007 4:29 PM