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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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Abstract

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.

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Acknowledgements

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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  1. Contributed equally to this work

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Collaborative Innovation Center of Hematology, Peking University, Beijing, 100044, China

    Jing Xue, Haixia Fu, Qian Jiang, Hao Jiang, Jing Lu, Lanping Xu, Kaiyan Liu, Xiaojun Huang & Xiaohui Zhang

  2. Departments of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, 100005, China

    Ru Feng & Hui Liu

  3. Department of Hematology, Beijing Tongren Hospital, Beijing, 100730, China

    Jingwen Wang

  4. Department of Hematology, Sichuan University West China Medical Center, Chengdu, 610041, China

    Ting Niu

  5. Department of Hematology, Shandong Provincial Hospital, Qingdao, 266003, China

    Xin Wang

  6. Peking University, People’s Hospital, Institute of Hepatic Diseases, Beijing, 100044, China

    Yandi Xie & Hao Wang

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  1. Jing Xue
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Correspondence to Xiaojun Huang or Xiaohui Zhang.

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Xue, J., Feng, R., Fu, H. et al. Combined prednisone and levothyroxine improve treatment of severe thrombocytopenia in hepatitis B with compensatory cirrhosis accompanied by subclinical and overt hypothyroidism. Sci. China Life Sci. 61, 924–933 (2018). https://doi.org/10.1007/s11427-017-9250-1

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