Does Epclusa Cause Elevated Liver Enzymes and Trigger Hyperthyroidism?

The hepatitis C medication Epclusa?

Hello Doctor, my mother is 76 years old and has a history of hypertension.
Last year, she was diagnosed with Hepatitis C and was prescribed Epclusa for treatment.
After completing the 8-week course, she stopped the medication at the end of December last year.
Since the end of treatment, her blood tests have shown elevated liver enzymes (her liver enzymes were normal before treatment).
In January, her ALT was 34, and in February, it increased to 57.
Recently, due to weight loss, she was found to have hyperthyroidism (which she did not have before).
Doctor, could the medication Epclusa cause an increase in liver enzymes and indirectly trigger hyperthyroidism?

Miss Zhu, 30~39 year old female. Ask Date: 2024/03/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

There are very few reports of this; it can be managed under the supervision of a physician.

Reply Date: 2024/03/28

More Info

Epclusa, a combination of sofosbuvir and velpatasvir, is an antiviral medication used to treat chronic hepatitis C. While it is generally well-tolerated, some patients may experience elevated liver enzymes (ALT and AST) during or after treatment. This elevation can be attributed to several factors, including the underlying liver disease itself, the body's response to the medication, or other concurrent health issues.

In your mother's case, it is important to consider that hepatitis C can cause fluctuations in liver enzyme levels, and the liver may take time to stabilize after the cessation of antiviral therapy. The increase in ALT from 34 to 57 after treatment could be a normal post-treatment response, especially if the liver is recovering from the viral infection. However, persistent elevation of liver enzymes warrants further investigation to rule out other potential causes, such as liver inflammation, fatty liver disease, or other hepatotoxic medications.

Regarding the potential link between Epclusa and hyperthyroidism, there is currently no direct evidence to suggest that this medication causes thyroid dysfunction. Hyperthyroidism can arise from various factors, including autoimmune conditions like Graves' disease, which is the most common cause of hyperthyroidism in older adults. It is essential to evaluate the thyroid function independently of the hepatitis C treatment, as the onset of hyperthyroidism may be coincidental.

In summary, while Epclusa can lead to elevated liver enzymes in some patients, it is crucial to assess the overall clinical picture, including the history of hepatitis C and any other underlying health conditions. If your mother is experiencing significant weight loss and newly diagnosed hyperthyroidism, it is advisable to consult an endocrinologist for a comprehensive evaluation of her thyroid function and to determine the appropriate management plan.

In addition to monitoring liver enzymes, it may be beneficial to conduct further tests, such as a liver ultrasound or fibroscan, to assess liver health post-treatment. If liver enzyme levels remain elevated or if there are any concerning symptoms, a hepatologist should be consulted to explore potential causes and treatment options.

Overall, while Epclusa is effective in treating hepatitis C, it is essential to monitor liver function and thyroid health closely, especially in older patients with pre-existing conditions. Regular follow-ups with healthcare providers will help ensure that any emerging issues are addressed promptly and appropriately.

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