Cytokine profile and efficacy of chemotherapy depending on thyroid state in patients with pulmonary tuberculosis

Abstract

Objective of the study is definition of cytokine balance and the outcomes of chemotherapy of tuberculosis patients depending on their thyroid state. Materials and methods: 60 tuberculosis patients with pulmonary: 30 persons with unchanged thyroid gland and 30 persons with autoimmune thyroiditis and followed subclinical hypothyroidism were compared for the structure and the function of thyroid gland, cytokine balance and outcomes of antituberculosis chemotherapy. Thyroid glands of all patients were scanned by ultrasound. The levels of free thyroxine, thyroid stimulating hormone and antibodies to thyroglobulin and thyroid peroxidase in the serum were defined. At the same time the levels of tumor necrosis factor-α, interferon- γ and interleukins-2, -6, and -4 were measured. Outcomes of chemotherapy was estimated on the ground of general cri­terions: term and rate of stopping of bacilli excretion and healing of caverns in lungs. Results and discussion: In a com­parative analysis of the data obtained, it was found that in tuberculosis patients with autoimmune thyroiditis and subclinical hypothyroidism compared with tuberculosis patients without thyroid pathology free thyroxine values in average decrease, the level of thyroid-stimulating hormone increases and levels of antibodies to both thyroglobulin and especially to thyroid peroxidase increase. In patients with concomitant autoimmune thyroiditis with subclinical thy­roiditis, levels of pro-inflammation cytokines TNF-α, INF-γ, IL-2, IL-6 were significantly lower when compared with patients without thyroid pathology, and the level of anti-inflammation cytokine IL IL-4 was higher in a group of patients with autoimmune thyroiditis. Efficacy of chemotherapy was better in tuberculosis patients without thyroid pathology. These changes can be explained by a lower level of T4 in the systemic circulation of people with autoimmune thyroiditis and subclinical hypothyroidism. Conclusion: subclinical hypothyroidism accompanying concomitant autoimmune thyroiditis suppresses cytokine response in tuberculosis patients. That is followed worsening of treatment response during antituberculosis chemotherapy. Screening of thyroid state is recommended for TB patients for timely definition of thyroid pathology and its compensation if needed for improvement of the outcomes of antituberculosis chemotherapy.