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Thyroid Disease Thyroid disease occurs in an estimated 2 to 13% of persons with chronic HCV.[38,39] In a study of 630 participants with chronic HCV and no cirrhosis, investigators found that 17% had anti-thyroglobulin antibodies, and 21% had antithyroid peroxidase antibodies.[38] Among patients with HCV in this study, the prevalence of hypothyroidism was 13%, and serum thyroid stimulating hormone (TSH) levels were significantly higher in those with chronic HCV when compared to control arms from both iodine-deficient and iodine-sufficient areas.[38] Sjgren's Syndrome Several studies suggest an association between HCV infection and Sjgren's syndrome.[40,41] In a meta-analysis evaluating the frequency of extrahepatic manifestations of HCV, authors found that the pooled prevalence of Sjgren's syndrome across 11 studies was 11.9% among HCV-positive individuals, in comparison to 0.7% among HCV-negative controls.[6] Similarly, in a multicenter registry of patients with chronic HCV and systemic autoimmune diseases, Sjgren's syndrome was the most frequently reported (47.5%) systemic autoimmune disease (47.5%).[34] Renal Disorders Renal Manifestations Associated with HCV Infection A subset of renal glomerular diseases are strongly associated with HCV infection.[42,43] In addition, individuals with chronic HCV can develop albuminuria without overt renal disease, particularly persons 60 years of age or older.[44,45] The evidence for HCV infection causing renal disease is mainly supported by epidemiologic data.[6,46,47,48,49] When HCV-related glomerulonephritis develops, it typically occurs many years, often decades, after initial infection with HCV