Thyroid Assessment in MS Patients on Interferon-Beta Therapy
abstracts & commentary
Sources: Monzani F, et al. Long term interferon-beta-1b therapy for MS: Is routine thyroid assessment always useful? Neurology 2000;55:549-552; Rotondi M, et al. Long-term treatment with interferon-beta therapy for multiple sclerosis and occurrence of Graves’ disease. J Endocrinol Invest 2000; 23:321-324.
Monzani and colleagues studied 31 multiple sclerosis (MS) patients on interferon-beta therapy for three years with attention to onset and progression of thyroid disease. In the first year of treatment there was a 33% incidence of early thyroid dysfunction (both hypo and hyperthyroid), with a particularly high incidence (75%) in patients with baseline Hashimoto’s thyroiditis. Many of these patients were clinically euthyroid with elevated anti-thyroid antibody titers.
Monzani and colleagues found that of the six patients who developed subclinical hypothyroidism in the first year, thyroid dysfunction persisted in only two. Monzani et al conclude that incident thyroid dysfunction typically occurs in the first year of interferon-beta treatment and is usually mild and transient. Regular monitoring of thyroid function tests was recommended in patients with baseline thyroid disease.
In a single case report, Rontondi and colleagues describe a 40-year-old MS patient who developed severe Graves’ disease after 22 months on interferon-beta therapy, requiring methimazole and propanolol treatment despite discontinuation of interferon-beta.
An extensive literature describes thyroid dysfunction in patients receiving interferon-alpha for hepatitis C or hematological malignancies. MS patients in general also appear to have a slightly higher incidence of autoimmune thyroid disease. Thus, the finding of thyroid disorder in MS patients on interferon-beta treatment is not surprising, but in most cases it does not seem to contradict initiating or continuing interferon-beta. —Michael Rubin
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