ART OF MEDICINE 2017

 

THE VALUE OF CYTOKINE IMBALANCE IN THE FORMATION OF INSULIN RESISTANCE IN PATIENTS WITH PRIMARY HYPOTHYROIDISM

 

T.S. Vatseba, N.V. Skrypnyk, O.М. Di-dushko

          SHEI "Ivano-Frankivsk National Medical University", Department of Endocrinology, Ivano-Frankivsk, Ukraine, tamara.vatseba@ gmail.com

  

Abstract

Abstract. The purpose of the study was to reveal the activity of the immune system of the body in hypothyroidism, to investigate the nature of the cytokine imbalance and its role in shaping the state of insulin resistance in patients with hypothyroidism of the thyroid gland. In this category of patients, the levels of proinflammatory cytokines: tumor necrotic factor - α (TNFα), interleukin-6 (IL-6) and adiponectin (AN) blood were taken for studying their associative interactions and role in the formation of IP in patients with primary hypothyroidism. The article presents literary and personal data on the role of TNF, IL-6, AN in the pathogenetic mechanisms of development of insulin resistance. 120 patients with primary hypothyroidism were examined, among them patients of different groups: with obvious hypothyroidism with obesity and with normal BMI, and patients with subclinical hypothyroidism with obesity and without overweight. In all groups of patients there is a significant hyperinsulinemia. Between the indices of HOMA IR and the level of TSH, a direct linear correlation dependence was established, which proves the dependence of the formation of IR on the severity of the hypofunction of the thyroid gland. The increase in the level of proinflammatory blood cytokines in patients with clear and hypoglycaemic episodes in comparison with the control group has been revealed. Levels of TNF-α and IL-6 in all groups were significantly higher than POP (p<0.05), the highest value of cytokines was found in patients of the I group  (p<0.05), which proves the excessive production of these "mediators" in patients with apparent hypothyroidism and obesity. Correlation analysis showed the presence of direct correlation bonds between TNF-α and IL-6 with TTG, the index HOMA IR and OT. We found the reduced level of adiponectin in all groups of patients compared to the control group (p<0.05). The smallest values of this cytokine were obtained in groups І and ІІІ, that is, in people with excessive body weight (р <0,05). Adiponectin was also decreased in patients with CG (p <0.05). The highest level of adiponectin in the blood was detected in patients of the group IV without obesity. The adiponectin content in serum of patients examined negatively correlated with the indicator of HOMA IR, OT and the level of TSH. Thus, the results of our study prove that the determination of the level of EI in the blood, the calculation of the Sago index and HOMA-IR may serve as a method for diagnosis of IP in patients with primary hypothyroidism. It has been proved that hypothyroidism is accompanied by the activation of the immune system of the body with an increase in TNF-α, IL-6 production and a reduction in the synthesis of adiponectin in the blood. Cytokine imbalance correlates with the severity of hypothyroidism. Obesity is an additional, but not unique factor in the hypothyroidism of the IR. Cytokine imbalance can be considered as a factor of the IP and a marker of increased risk of cardiovascular disease in hypothyroidism.

 

Key words: hypothyroidism, insulin resistance, obesity, adiponectin, tumor necrotic factor - α, interleukin - 6.

 

Full text: PDF (Rus)

References
  1. Амбросова Т.М. Прогностичні маркери формування і прогресування ожиріння у хворих на артеріальну гіпертензію / Т.М. Амбросова, О.М. Ковальова, Т.В. Ащеулова // Актуал. пробл. сучас. мед. – 2012. – Т. 12, № 3 (39). – С. 4-7.
  2. Вацеба Т. С. Спосіб оптимізації лікування гіпотиреозу в умовах йодної недостатності шляхом впливу на інсулінорезистентність / Т. С. Вацеба, Н. В. Скрипник // Ліки України. –  – № 8(174) – С.62– 66.
  3. Дідушко О.М. Особливості ліпідного обміну у хворих на гіпотиреоз / О.М. Дідушко: матеріали науково-практичної конференції з міжнародною участю [«Проблеми атеросклерозу як системної патології»]. – Харків, 2014. – С. 40.
  4. Мітченко О.І. Серцево-судинний ризик на тлі дисфункції щитоподібної залози / О.І. Мітченко, В.Ю. Романов, А.О. Логвиненко, М.В. Гвоздик І.В. Чулаєвська // Укр. кардіол. журнал. – 2011. – №5. – С.23-29.
  5. Присяжнюк И.В., Пашковская Н.В. Особенности цитокинового профиля у больных гипотиреозом с сопутствующим хроническим холециститом / И.В. Присяжнюк, Н.В. Пашковская // Международный эндокринологический журнал. – – №9 (56). – С. 130-134.
  6. Скрипник Н.В. Роль гіпотиреозу у формуванні інсулінорезистентності / Н. В. Скрипник // Клінічна ендокринологія та ендокринна хірургія. – – № 4 (29). –  С. 47-53.
  7. Скрипник Н.В., Вацеба Т.С. Метаболічний синдром і гіпотиреоз: патогенетичні взаємозв’язки, діагностика, лікування / Н.В. Скрипник, Т.С. Вацеба // Діабетологія, тиреоїдологія, метаболічні розлади. – 2017. – № 1 (37). – С. 60-63.
  8. Cooper DS, Biondi B. Subclinical thyroid disease / D.S. Cooper, Biondi // Lancet. –  2012. – Vol. 379. – P.1142-1154.
  9. Franklyn J.A. The Thyroid-too much and too little across the ages. The consequences of subclinical thyroid dysfunction /A. Franklyn. // Clin. Endocrinol. – 2013. – Vol.78. – P.1-8.
  10. Hanna M., Marcin M, Monika O. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease /  Hanna, M. Marcin, O. Monika // Endocrin Polska. – 2014. – Vol.65. – P.150-155.