Non-cancerous thyroid lesions: immunologic and surgical evaluation

The present study was designed to determine T helper-l/T helper-2 [Th[1]/Th[2]] 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. 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 [99m] Tc pertechnetate scintigraphy for establishment of diagnosis. Patients with HT received medical treatment and were followed-up, while patients with GD and MNG underwent near-total thyroidectomy. Preoperative blood samples were collected from patients and control subjects for ELISA estimation of serum levels of interleukin-2 [IL-2], IL-18, IL-4 and IL-5. Patients 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. 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 lL-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 IL-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 IL-5 were significantly higher in patients with GD compared to patients with HT or MNG with a significantly but non-significantly higher percentage of increase of IL-5 and IL-4, respectively, in patients with MNG compared to those with HT. It could be concluded that there was a disturbed pattern of Th[1]/Th[2] cytokines in patients with non-cancerous thyroid lesion in favor of humoral pattern of immune response in GD with predominance of Th[2] cytokines and a Th[1]-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