Objectives: The present study was designed to determine T helper-1/T helper-2 (Thi/Th2) pattern in patients
with Graves' disease (GD), benign multinodular goiter (MNG) and Hashimoto thyroiditis (HT) and evaluate
the applicability of near-total thyroidectomy as a therapeutic strategy for surgical interference.
Patients & Methods: The study included 75 patients (56 females and 19 males; with mean age of 43.8±8.2
years) with thyroid swelling and 15 healthy volunteers (control group). Patients underwent clinical
examination including direct laryngoscopy using fiberoptic endoscopy, laboratory investigations and
ultrasonographic and 99mTc pertechnetate scintigraphy for establishment of diagnosis. Patients with HT received
medical treatment and were followed-up, while patients with GD and MNG underte t near-total
thyroidectomy. Preoperative blood samples were collected from patients and control subjects for EL1SA
estimation of serum levels of interleukin-2 (IL-2), IL-18, IL-4 and 1L-5. Thtictits were observed for appearance of
postoperative manifestations of recurrent laryngeal nerve (RLN) palsy and,/or hypoparathyroidism. Mean
operative time, duration of wound drainage and hospital stay were recorded.
Results: The study included 43 patients with GD (8 of them had thyroid orbitopathy), 17 patients had MNG
and the remaining 15 patients had HT. All patients had smooth intraoperative course and no patient had
permanent RLN palsy, but 4 (6.7%) patients had transient unilateral RLN palsies that recovered spontaneously
after a mean duration of 24.5 ± 11.6 days. Temporary hypocalcaemia occurred in 9 patients (15%) and
permanent hypoparathyroidism resulted in one (1.7%). All patients developed wound edema, 7 patients had
wound seroma and 2 patients had wound infection. Mean serum levels of IL-2, IL-4 and IL-5 were significantly
higher in patients compared to control levels irrespective of the type of thyroid lesion. Mean serum levels of IL-
18 were significantly higher in patients with HT and MNG disease and non-significantly higher in patients
with GD compared to control levels. Moreover, mean serum levels of I1-2 and IL-18 were significantly higher
and mean serum levels of IL-4 and IL-5 were significantly lower in patients with HT and MNG disease
compared to those with GD and in MNG patients compared to those with HT. The percentage of postoperative
increase of serum IL-2 and IL-18 levels relative to the median control level were significantly higher in patients
with HT than in patients with GD or MNG with a significantly higher percentage of increase in patients with
MNG compared to those with GD. On the other hand, the percentages of increase of IL-4 and 1L-5 were
significantly higher in patients with GD compared to patients with HT or MNG with a significantly but nonsignificantly
higher percentage of increase of 1L-5 and IL4, respectively, In patients with MNG compared to
those with HT.
Conclusion : It could be concluded that there was a disturbed pattern of 17i2/7'h2 cytokines in patients with
non-cancerous thyroid lesion in favor of humoral pattern of immune response in GD with predominance of Th2
cytokines and a Thi-pattern of immune response characteristic of cellular immunity is dominant in HT. Also,
near total thyroidectomy was found appropriate therapeutic modality with transient minimal complications for
patients with MNG or GD.
977 |
