Relating circulating thyroid hormone concentrations to serum interleukins-6 and -10 in association with non-thyroidal illnesses including chronic renal insufficiency

<p>Abstract</p> <p>Background</p> <p>Because of the possible role of cytokines including interleukins (IL) in systemic non-thyroidal illnesses' (NTI) pathogenesis and consequently the frequently associated alterations in thyroid hormone (TH) concentrations constituting the euthyroid sick syndrome (ESS), we aimed in this research to elucidate the possible relation between IL-6 & IL-10 and any documented ESS in a cohort of patients with NTI.</p> <p>Methods</p> <p>Sixty patients and twenty healthy volunteers were recruited. The patients were subdivided into three subgroups depending on their underlying NTI and included 20 patients with chronic renal insufficiency (CRI), congestive heart failure (CHF), and ICU patients with myocardial infarction (MI). Determination of the circulating serum levels of IL-6 and IL-10, thyroid stimulating hormone (TSH), as well as total T4 and T3 was carried out.</p> <p>Results</p> <p>In the whole group of patients, we detected a significantly lower T3 and T4 levels compared to control subjects (0.938 ± 0.477 vs 1.345 ± 0.44 nmol/L, p = 0.001 and 47.9 ± 28.41 vs 108 ± 19.49 nmol/L, p < 0.0001 respectively) while the TSH level was normal (1.08+0.518 μIU/L). Further, IL-6 was substantially higher above controls' levels (105.18 ± 72.01 vs 3.35 ± 1.18 ng/L, p < 0.00001) and correlated negatively with both T3 and T4 (r = -0.620, p < 0.0001 & -0.267, p < 0.001, respectively). Similarly was IL-10 level (74.13 ± 52.99 vs 2.64 ± 0.92 ng/ml, p < 0.00001) that correlated negatively with T3 (r = -0.512, p < 0.0001) but not T4. Interestingly, both interleukins correlated positively (r = 0.770, p = <0.001). Moreover, IL-6 (R²= 0.338, p = 0.001) and not IL-10 was a predictor of low T3 levels with only a borderline significance for T4 (R²= 0.082, p = 0.071).</p> <p>By subgroup analysis, the proportion of patients with subnormal T3, T4, and TSH levels was highest in the MI patients (70%, 70%, and 72%, respectively) who displayed the greatest IL-6 and IL-10 concentrations (192.5 ± 45.1 ng/L & 122.95 ± 46.1 ng/L, respectively) compared with CHF (82.95 ± 28.9 ng/L & 69.05 ± 44.0 ng/L, respectively) and CRI patients (40.05 ± 28.9 ng/L & 30.4 ± 10.6 ng/L, respectively). Surprisingly, CRI patients showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to CHF patients (40%, 45%, & 26% vs 35%, 25%, & 18%, respectively).</p> <p>Conclusion</p> <p>the high prevalence of ESS we detected in NTI including CRI may be linked to IL-6 and IL-10 alterations. Further, perturbation of IL-6 and not IL-10 might be involved in ESS pathogenesis although it is not the only key player as suggested by our findings in CRI.</p

Generalized Vascular Damage Including Glomerular Dysfunction In Newly-Detected Type 2 Diabetic Patients

Aim: Diabetes mellitus (DM) is considered a vascular disease, we intended to determine prevalence and nature of generalized and glomerular vascular abnormalities the moment it is diagnosed (ND-DM) in a cohort of patients with Arabic descent. Over 9 months, 216 out of 1208 asymptomatic Saudies were referred by the Primary Care Physicians on having risk factors for future development of DM for DM screening. Methods: For the 54 ND-DM patients and 18 non-diabetic controls, clinical examination including body mass index (BMI) and waist:hip ratio (WHR), ultrasound determination of common carotid artery (CCA) intimal-medial thickness (IMT), hemoglobin A1c (A1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), CRP, albuminuria, serum creatinine (sCr), and glomerular filtration rate (eGFR) were done. Results: About 4.5% were unaware of their diabetes and they had significant (35/54 vs 5/18 p=0.01) preclinical atherosclerosis (increased IMT and/or atheromatous plaques) with similar age, HDL-C, CRP and eGFR compared to controls. Also, they had pathologic microalbuminuria ([μA] 145.4±201.4 vs 18.9±7.1, p=0.013) with higher BMI (29.5±3.6 vs 27.2±1.8, p=0.043), WHR (0.94±0.12 vs 0.79±0.1, p=0.001), TC (5.1±0.9 vs 3.8±0.6, p=0.001) and TG (2.3±0.9 vs 1.2±0.4, p=0.001) compared to controls. Diabetic nephropathy (DN), as inferred from glomerular damage marker μA was significantly prevalent (17/54, p=0.014) in ND-DM patients. Those with DN had more IMT (0.96±0.1 vs 0.77±0.1, p=0.0001), WHR (0.98±0.1 vs 0.91±0.13, p=0.037), TC (5.4±0.7 vs 4.9±0.9, p=0.049) and TG (2.7±0.4 vs 2.02±0.4, p=0.012), lower eGFR (86.4±12 vs 104.1±13, p=0.0001), older age (40.9±5 vs 37.9±4, p=0.028) and worse glycamic control (A1c=8.1±1.6 vs 7.3±1.5, p=0.048). Also, diabetic retinopathy (DR) was significantly prevalent (n=19) in ND-DM patients (p=0.047). Interestingly, DN and DR, were significantly correlated with each other (r=0.841, p=0.0001) and with IMT (r=0.38, p=0.005 and r=0.35, p=0.009, respectively). Conclusion: The newly-detected Saudi diabetics already had more vascular changes including glomerular damage than normal glucose-tolerant subjects with clustering of risk factors in particular abdominal obesity, and dyslipidaemia