Pegylated interferon alpha (PEG-IFN-α) is a key therapy for chronic hepatitis B (CHB) capable of achieving clinical cure, but it frequently triggers thyroid dysfunction. To address the lack of unified clinical guidelines, experts from the National Medical Center for Infectious Diseases have published a new consensus in Infectious Diseases & Immunity .
The consensus provides 15 practical recommendations, systematically detailing the incidence, risk factors, and mechanisms of these adverse reactions. Crucially, it highlights that hyperthyroidism or subclinical hyperthyroidism during treatment may actually correlate with higher hepatitis B surface antigen clearance rates, reflecting immune activation rather than being an automatic signal to stop therapy.
The document emphasizes comprehensive pre-treatment assessments and regular monitoring. It outlines a clear pathway to differentiate Graves' disease from destructive thyroiditis—a critical step, as Graves' disease requires pausing interferon and using antithyroid drugs, while destructive thyroiditis can be managed with beta-blockers while continuing antiviral therapy. For hypothyroidism, thyroid hormone replacement therapy can be safely initiated without stopping interferon.
By establishing a graded management strategy, this consensus enables clinicians to effectively balance treatment efficacy and patient safety, ensuring that CHB patients can safely pursue a functional cure.
Infectious Diseases & Immunity
Commentary/editorial
People
Expert consensus on the management of thyroid adverse reactions related to pegylated interferon therapy for chronic hepatitis B
30-Oct-2026