Clinical and metabolic parameters and low-grade inflammation in patients with autoimmune hypothyroidism: Abstract of the Doctoral Dissertation in Medical Sciences, 321.02 – Endocrinology

Abstract

Thesis structure: The thesis includes an introduction, 7 chapters, general conclusions, recommendations, bibliography (354 references), 107 text pages, 24 figures, 13 tables, 4 inovator certificates, 4 implementation acts, appendices. The results generated 8 in extenso publications, 12 thesis at international and national conferences, 1 National Clinical Guideline and 13 presentations at international and national congresses. Key words: autoimmune hypothyroidism, subclinical hypothyroidism, autoimmune thyroiditis, low grade inflammation, hs-CRP, cardiovascular risk, nonHDL-cholesterol, creatine kinase, levothyroxine, quality of life, ThyPRO-39. Aim of the study: To evaluate biomarkers of low-grade systemic inflammation and their relationship to clinical and metabolic parameters, and evaluation of quality of life in individuals with autoimmune hypothyroidism, before and after treatment with levothyroxine, in order to integrate the concept of low-grade inflammation into the management of autoimmune hypothyroidism. Objectives: Characterisation of the clinical and hormonal profile in individuals with autoimmune hypothyroidism. Analysis of the metabolic profile in individuals with autoimmune hypothyroidism. Assessment of inflammatory biomarkers in individuals with autoimmune hypothyroidism. Evaluation of the effect of levothyroxine treatment on clinical and metabolic parameters, and inflammatory biomarkers. Assessment of quality of life in individuals with autoimmune hypothyroidism before and after levothyroxine treatment. Scientific novelty: The presence of low-grade inflammation in individuals with autoimmune hypothyroidism has been identified, which represents an increased cardiovascular risk factor, especially in young non-obese women, considered a priori to have low cardiovascular risk. It was determined that individuals with very high creatine phosphokinase (>1000 U/L) have a hs-PCR level < 1 mg/L, indicating a low inflammatory process. The study highlighted the complex interaction between low-grade inflammation, lipid metabolism, renal function and hypothyroidism. The results contribute to the understanding of the common pathogenic mechanisms between thyroid dysfunction, low-grade inflammation and cardiovascular risk, offering new perspectives for the evaluation and management of patients with hypothyroidism. Original are the data on the significant negative impact of the disease on quality of life, especially on the Hypothyroid Symptoms, Goitre Symptoms, and Cosmetic Complaints scales, as well as the persistence of some symptoms, despite substitution treatment, which suggests that standard levothyroxine therapy is not always sufficient and an individualized approach is necessary in the management of hypothyroidism. Theoretical significance: The research contributes to the deepening of knowledge regarding the role of low-grade inflammation in autoimmune hypothyroidism and highlights its interaction with thyroid dysfunction, lipid metabolism and cardiovascular risk factors. The presence and persistence of low-grade inflammation after the initiation of levothyroxine treatment suggests pathogenetic mechanisms in the evolution of hypothyroidism, independent of the normalization of thyroid gland function. Practical value: the need to assess the presence of low-grade inflammation as a relevant pathogenic factor and the degree of inflammation. Identification of the persistence of inflammation is also appropriate after the initiation of levothyroxine treatment. The application of the ThyPRO-39 questionnaire revealed a considerable impairment of quality of life, despite the substitution treatment with levothyroxine, which emphasizes the need for an extensive diagnostic and therapeutic approach, which provides not only the normalization of hormonal parameters, but also the assessment and improvement of QOL. The results thus contribute to the development of individualized clinical recommendations in the management of this condition.