Combined prednisone and levothyroxine improve treatment of severe thrombocytopenia in hepatitis B with compensatory cirrhosis accompanied by subclinical and overt hypothyroidism
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The aim of the present study was to investigate the relationship between hypothyroidism and thrombocytopenia in hepatitis B-related compensatory liver cirrhosis and to determine whether treatment with levothyroxine and prednisone is superior in a multicenter, open-label, observational study in China. In total, 125 consecutive hepatitis B-related compensated liver cirrhosis patients with severe thrombocytopenia accompanied by hypothyroidism were included. The patients were divided into four groups according to treatment strategy: a control group (n=29), a prednisone group (n=25), a levothyroxine group (n=32) and a prednisone plus levothyroxine group (n=39). Severe thrombocytopenia was more prevalent in hepatitis B-associated compensatory liver cirrhosis patients with hypothyroidism than in euthyroid patients (29.6% vs. 14.7%, P<0.05). Combination treatment with prednisone and levothyroxine decreased the risk of bleeding and improved platelet recovery compared to control treatment and treatment with either prednisone or levothyroxine alone. The platelet count before therapy, serum thyroid stimulating hormone and combination treatment with prednisone and levothyroxine were associated with bleeding events. Therefore, the present study suggests that hypothyroidism is associated with severe thrombocytopenia in hepatitis B-associated compensatory liver cirrhosis. Treatment with prednisone plus levothyroxine may present a novel approach in these patients.
Keywordshepatitis B cirrhosis thrombocytopenia hypothyroidism treatment
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The authors thank their nurses’ team and technicians in executing this study. We also thank Yang Wang from State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital & Cardiovascular Institute for statistic analysis. This work was supported by National Natural Science Foundation of China (81470343, 81670116), National Natural Science Foundation for Young Scholars of China (81600132), Key Program of National Natural Science Foundation of China (81730004), Beijing Natural Science Foundation (7171013), Beijing Municipal Science and Technology Commission (Z171100001017084), the National Key Research and Development Program of China (2017YFA0105503) and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81621001).
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