Prognosis of remote results of surgical treatment of nodular endemic goiter with autoimmune thyroiditis
Abstract
Aim. Determination of markers for clinical course prediction and choice of surgical intervention in patients with nodular goiter againstthe background of autoimmune thyroiditis by studuing the activity of oxidant, autoimmune and apoptotic processes.
Materials and Methods.Ninety-fivepatients with unilateral nodular and multinodulargoiter againstthe background of autoimmune thyroiditis after the operation and in the remote postoperative period were examined. The activity of peroxide oxidation and the state of antioxidant systems, the level of proinflammatory cytokines, the activity of apoptotic processes, the thyroid gland function, levels of thyroid peroxidase antibodies, and structural changes in the gland revealed by ultrasound were examined.
Result and Discussion. The study shows that in patients with nodulargoiter againstthe background of autoimmune thyroiditis a significant increase in the index of peroxidation and decrease in the activity of antioxidant defense systems against the suppression of apoptotic processes and the activation of proinflammatory cytokines are seen in the remote period after the surgical treatment. These processes lead to functional failure, hyperplasia and progressive structural pathology of the thyroid gland, leading ultimately to progressive functional thyroid gland failure and inadequate long-term outcome of treatment.
Conclusions. The conducted study allowed clarifyingindications and contraindications to the selection of surgical procedures in patients with endemic nodular goiter against the background of autoimmune thyroiditis, considering the parameters of oxidative processes, the level of proinflammatory cytokines, apoptosis and the functional capacity of the thyroid gland.
References
Shahrani AS, El-Metwally A, Al-Surimi K, et al. The epidemiology of thyroid diseases in the Arab world. Journal of Public Health and Epidemiology 2016;8(2):17-26. https://doi.org/10.5897/JPHE2015.0713
Caturegli P, De Remigis A, Rose NR. Hashimoto's thyroiditis: clinical and diagnostic criteria. Autoimmun Rev 2014; 13:391-7. https://doi.org/10.1016/j.autrev.2014.01.007
Mikos H, Mikos M, Obara-Moszynska M, Niedziela M. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol 2014;65(2):150-5. https://doi.org/10.5603/EP.2014.0021
Ai J, Leonhardt JM, Heymann WR. Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations. J Am Acad Dermatol 2003; 48: 641-659. https://doi.org/10.1067/mjd.2003.257
Carrasco Llatas M, Seijas Rosales T, Lopez Molla C, Tamarit Conejeros JM, Fern?ndez Mart?nez S, Dalmau Galofre J. Hemithyroidectomy: when it is necessary an intraoperative frozen-section biopsy? Acta Otorrinolaringol Esp. 2008; 59(4):159-62. https://doi.org/10.1016/S0001-6519(08)73286-2
Ramos-Levi AM, Marazuela M. Pathogenesis of thyroid autoimmune disease: the role of cellular mechanisms. Endocrinol Nutr 2016;63(8):421-9. https://doi.org/10.1016/j.endonu.2016.04.003
Diaconescu MR, Glod M, Costea I, Grigorovici M, Diaconescu S. Indications for surgery in thyroiditis. Chirurgia (Bucur). 2012; 107(3):337-42.
Erdal M, Sahin M, Hasimi A, Uckaya G, Kutlu M, Saglam K. Trace element level-s in Hashimoto's thyroiditis patients with subclinical hypothyroidism. Biol Trace Elem Res 2008;123(1-3):1-7. https://doi.org/10.1007/s12011-008-8117-8
Ganesh BB, Bhattacharya P, Gopisetty A, Prabhakar BS. Role of cytokines in the pathogenesis and suppression of thyroid autoimmunity. Journal of Interferon & Cytokine Research 2011;31(10):721-31. https://doi.org/10.1089/jir.2011.0049
Guan LJ, Wang X, Meng S, et al. Increased IL-21/IL-21R expression and its proinflammatory effects in autoimmune thyroid disease. Cytokine 2015;72(2):160-5. https://doi.org/10.1016/j.cyto.2014.11.005
Sheremet MI, Shidlovskyi VO, Sydorchuk LP. Assessment of proliferation and apoptosis markers in patients with autoimmune thyroiditis. Journal of Education, Health and Sport 2016;6(1):179-188.
Rautureau GJ, Day CL, Hinds MG. Intrinsically disordered proteins in BCL-2 regulated apoptosis. Int J Mol Sei 2010; 11 (4):1808-1824. https://doi.org/10.3390/ijms11041808
Kinnally KW, Antonsson B. A tale of two mitochondrial channels, MAC and PTP, in apoptosis. Apoptosis 2007; 12: 857-868. https://doi.org/10.1007/s10495-007-0722-z
Sheremet MI, Shidlovskyi VO, Sydorchuk LP. Analysis of a process of peroxidation, caspase-3 and caspase-8 in patients with autoimmune thyroiditis. Journal of Education, Health and Sport 2015;5(11):117-125. https://doi.org/10.21802/gmj.2016.3.50
Seifman MA, Grodski SF, Bailey M, Yeung MJ, Serpell JW. Surgery in the setting of Hashimoto's thyroiditis. [et al.] ANZ J Surg. 2011;81(7-8):519-23. https://doi.org/10.1111/j.1445-2197.2011.05707.x
Sheremet MI, Sydorchuk LP, Shidlovskyi VO, Bedenyuk AD. Research of prognostic markers of proliferation and apoptosis in patients with nodular goiters combined with autoimmune thyroiditis. Arch Balk Med Union 2016; 51 (4): 488-491.
Dai R, Ahmed SA. MicroRNA, a new paradigm for understanding immunoregulation, inflammation, and autoimmune diseases. Transl Res 2011; 157:163-79. https://doi.org/10.1016/j.trsl.2011.01.007
Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012;18(6):988-1028. https://doi.org/10.4158/EP12280.GL
Sheremet MI, Sydorchuk LP, Shidlovskyi VO, et al. Remote results of hemithyroidectomy and their prognostication in patient with unilateral nodular goiter combined with autoimmune thyroiditis. Arch Balk Med Union 2018;53(1):41 46.
Sheremet MI. Optimization of complex treatment of patients with nodal forms of goiter on the background of auto immune thyroiditis and prophylaxis of postoperative complications. Medical forum 2017;12 (12): 125 129. (Ukrainian)
Sheremet MI, Shidlovskyi VO, Shidlovskyi OV, et al. Drug therapy in autoimmune thyroiditis. Arch Balk Med Union 2018;53(3):373-80. https://doi.org/10.31688/ABMU.2018.53.3.10
This work is licensed under a Creative Commons Attribution 4.0 International License.
ISSN 
ISSN 
