POSTOPERATIVE HYPOTHYROIDISM: SOME CLINICAL AND HUMORAL ASPECTS
Objectives. To specify reasons, features of humoral changes and principles of correction of the early postoperative hypothyroidism (POH). Methods. The patients were divided into two groups depending on the conducted treatment. The first group was made up of the patients with early postoperative hypothyroidism (24), the second group - the patients (19) without clinical or laboratory signs of postoperative hypothyroidism. The content of peroxidation products and antioxidant protection, the thyroid and immune status were studied before the surgery on the thyroid gland, and on the 10th day after the surgery. Results. It has been established that in 75% of cases the postoperative hypothyroidism appeared on the 10th day of the postoperative period after thyroidectomy and maximum subtotal resection of the thyroid gland in patients with the initial euthyroid and hypothyroid (any volume of the operation). The patients from the first group had significant decrease of indicators of cytokines (IL-4, IL-6, IL-10, TNF-α), humoral (IgA, IgG) and cellular immunity (lymphocytes, СD3+, CD4+, CD8+, СД16+, СД25+) in comparison with the initial level and the similar figures of the patients from the second group. In the first group patients with POH the activation of lipid peroxidation (LPO) and the reduction of antioxidant protection (AOP) due to the increasing of the level of diene conjugates and hydroperoxides lipids are registered as well as the reduction of vitamin E content. Conclusions. The factors enabling to predict the occurrence of early POH during the recent 10 days of the postoperative period are considered to be the surgery of thyroidectomy and maximal subtotal resection of the thyroid gland on the euthyroid background as well as the initial hypothyroidism at any volume of the surgery. Early postoperative hypothyroidism is accompanied by the secondary immunodeficiency, the activation of lipid peroxidation and the decrease of hydroperoxides lipids. The rehabilitation of the postoperative hypothyroidism patients should include the correction of hormonal and immune disorders.