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Is There A Connection Between Hepatitis C and Thyroid Health?

Published August 5th 2013

Hepatitis C is a condition that is due to a virus, and as a result causes inflammation of the liver.  Morbidity and mortality are increasing among an estimated 2.7-3.9 million people in the United States living with hepatitis C virus (HCV) infection, and most people are unaware of their infectious status (1) [1].  People who are most at risk of hepatitis C include those who are born to a mother who had hepatitis C, those who have regular exposure to blood (i.e. a health care employee who works in a hospital), someone who injects drugs and shares needles, someone who has unprotected sex, those who receive an organ transplant or a blood transfusion, and even those people who receive tattoos have a slight risk if the needles weren’t disinfected properly.

Hepatitis C is transmitted through the fluids of the body, usually through the blood, and thus the only way to get hepatitis C is by coming into contact with the bodily fluids of someone else who has this virus.  There are some well-documented instances of acute hepatitis C occurring after a defined sexual exposure (2) [2].  As for whether hepatitis C can be transmitted through the saliva, this remains controversial (3) [3].

Most people who have recently been infected with hepatitis C don’t have any symptoms (4) [4].  Some people have a yellowing of the skin, known as jaundice, which usually goes away (4) [4].  But some of the symptoms associated with chronic infection of hepatitis C include pain in the right upper abdomen, abdominal swelling, clay-colored or pale stools, dark urine, fatigue, fever, itching, jaundice, loss of appetite, nausea, and vomiting (4) [4].  This doesn’t mean that everyone with hepatitis C will experience these symptoms, as some people will be asymptomatic, while others will experience one or more of these symptoms.  Although most people with this condition have a relatively mild disease with slow progression, chronic and progressive hepatitis C carries significant morbidity and mortality and is a major cause of cirrhosis, end-stage liver disease, and liver cancer (5) [5].

Testing For Hepatitis C

There are two categories of diagnostic tests for hepatitis C (6) [6]. The first involves serological assays which detect antibodies to the hepatitis C virus.  The second type of diagnostic tests looks to detect, quantify, and/or characterize HCV RNA genomes within an infected patient.  One study also evaluated the use of a rapid on-site anti-HCV test for hepatitis C virus infection, but found that this method has limited specificity, and that a positive result warrants re-evaluation with a certified serologic assay (7) [7].  One of the problems is that the symptoms of hepatitis C vary, and as a result most medical doctors don’t do enough testing for hepatitis C.  So for example, someone might come into a medical doctor’s office and have some of the symptoms associated with HCV, yet still not receive the appropriate testing.

How Does Hepatitis C Affect Thyroid Health?

Numerous studies have looked into the relationship between hepatitis C and thyroid conditions.  One study looked at the prevalence of thyroid disorders in 630 patients with chronic hepatitis due to HCV infection (8) [8].  The study showed that on average, the TSH levels were higher, while the free T3 and free T4 levels were lower in patients with chronic hepatitis C.  The anti-thyroglobulin and anti-thyroperoxidase antibodies also were higher.  The study concluded that both hypothyroidism and thyroid autoimmunity are more common in patients with chronic hepatitis C.  Another study showed that patients receiving interferon therapy for hepatitis C are more susceptible to developing autoimmune thyroid disease, with molecular mimicry and epitope spreading being potential pathogenic mechanisms (9) [9].  Another study found hepatitis C virus RNA in a fifth of patients with Graves’ Disease but not in patients with Hashimoto’s Thyroiditis (10) [10].

One thing to also keep in mind is that those with a compromised immune system might be more susceptible to contracting an infection such as hepatitis C.  One study did show that the prevalence of hepatitis C in patients with Hashimoto’s Thyroiditis was slightly increased, while the prevalence of hepatitis A and B viruses is not increased (11) [11].  Just as is the case with most other pathogens, exposure to hepatitis C doesn’t necessarily lead to a chronic infection.  In about 30% of patients, the virus is eliminated during the acute phase of the infection by T cell-mediated antiviral mechanisms. In the remaining 70% of patients, the hepatitis C virus persists for decades. (12) [12].

What Conventional Treatment Methods Are Available?

Interferon treatment has been the main treatment for chronic hepatitis over the years.  Although the exact role of interferon treatment of hepatitis C is not fully understood, besides its antiviral effects, interferon is also an immune modulator (13) [13].  But while interferon treatment can be effective in preventing chronic infection of hepatitis C when administered to those with acute hepatitis C (14) [14], side effects are still common. Several side effects such as fever, headache fatigue, arthralgias, and myalgias are common with interferon therapy, especially with the initial injections (13) [13].  Other adverse events effects may require dose modification or even discontinuation of therapy in 2% to 10% of patients (13) [13].

In addition, interferon therapy can potentially exacerbate certain autoimmune conditions (13) [13].  In fact, one study I came across showed that interferon-alpha therapy triggered a case of Hashimoto’s Thyroiditis in someone with hepatitis C (14) [14].  Another study showed that Graves’ Disease was triggered following interferon therapy for a chronic hepatitis C infection (15) [15].  The reason for this is because interferon-alpha is known to alter the balance between Th1 and Th2 cells, and so interferon-alpha can potentially trigger an autoimmune response by changing the Th1/Th2 balance (16) [16].

Recently two protease inhibitors have become available for use (17) [17] (18) [18].  These are telaprevir and boceprevir, and when used in combination with interferon therapy this offers patients an improved chance of overcoming chronic hepatitis C (18) [18].  However, persistent limitations to hepatitis C treatment still exist for patients with prior treatment failure and comorbid conditions and patients on newer therapies suffer additional therapy-limiting side effects and drug-drug interactions (19) [19].

A new drug, Sofosbuvir, provides some future hope for those with chronic hepatitis C virus.  Sofosbuvir, along with the drug ribivarin, attack the virus itself, preventing the virus from replication (20) [20].

Can Natural Treatment Methods Help With Hepatitis C?

When someone has an autoimmune thyroid condition, such as Graves’ Disease or Hashimoto’s Thyroiditis, the goal is to address the autoimmune component.  So ultimately the goal is to restore the health of the immune system, although in order to accomplish this, certain areas might need to be addressed such as the adrenals and gut.  Hepatitis C is caused by a pathogen, and the best way of dealing with any pathogen is to have a healthy immune system.  I mentioned earlier that in about 30% of patients who are exposed to the hepatitis C virus the virus is eradicated by the antiviral mechanisms of the immune system.  While genetics might play a role in this to some extent, having a healthy immune system is without question also an important factor for those who are exposed to this virus.

But how about those people who have a chronic hepatitis C infection?  Well, in this case the virus most likely won’t be eradicated through a natural treatment approach, but it’s still important to have a healthy immune system in order to help keep the virus in check.  And there definitely are some things you can do from a natural treatment perspective.

In addition to offering immune system support, since hepatitis C affects the liver it would make sense to offer liver support to patients.  Silymarin is an extract from milk thistle, and there is evidence that taking this herb can help people with hepatitis C (21) [21].  However, the results are conflicting, as some studies show that taking silymarin isn’t of help to those with hepatitis C (22) [22].  I think taking milk thistle can help, especially during acute hepatitis C.  But without question I wouldn’t expect this herb alone to provide a cure for chronic hepatitis C.

Curcumin, which is a polyphenolic compound from the herb turmeric, has anti-viral activity against numerous pathogens, including the influenza virus, adenovirus, coxsackievirus, and HIV (23) [23].  And there is evidence that curcumin can also inhibit the replication of hepatitis C (24) [24] (25) [25] (26) [26].  Curcumin can also help with the proinflammatory cytokines associated with autoimmune thyroid conditions by inhibiting cytokine-mediated NF-kappa B activation, and so those people with Graves’ Disease and Hashimoto’s Thyroiditis who have hepatitis C will want to consider adding turmeric to their food, or might want to take a separate supplement.  Turmeric really is a wonderful herb, and if you haven’t done so already I would definitely check out my article “Turmeric and Thyroid Health [27]“.

Lactoferrin is a protein found in cow’s milk, as well as human milk.  Colostrum, which is the first milk produced after a baby is born, contains high levels of lactoferrin.  And there are a few studies which show that taking lactoferrin can benefit people with hepatitis C.  One study showed evidence that lactoferrin is a potential candidate as an anti-HCV reagent that may be effective for the treatment of patients with chronic hepatitis (27) [28].  Another study concluded that lactoferrin is a potential useful adjunct treatment for patients with chronic hepatitis C (28) [29].  So while lactoferrin by itself probably won’t provide a cure for chronic hepatitis, it should be considered as part of a natural treatment protocol.

In summary, millions of people have hepatitis C, and it’s common for people with hepatitis C to also have thyroid and autoimmune thyroid conditions.  Having a healthy immune system is of course important for anyone who has hepatitis C and/or an autoimmune thyroid condition.  Conventional treatment methods for chronic hepatitis C infection include interferon treatment and protease inhibitors, although there are some new drugs which attack the virus itself.  Just as  is the case with medication, natural treatment methods are more effective when dealing with acute hepatitis C infections, although they can potentially some people dealing with chronic hepatitis C infections.