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Thyroid function changes and cytokine alterations following major surgery.

Ioannis Ilias1, Marinella Tzanela, Irini Mavrou

  • 1Department of Endocrinology, Elena Venizelou Hospital, Athens, Greece. iiliasmd@yahoo.com

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Summary
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Surgical stress triggers cytokine release, including tumor necrosis factor-alpha (TNF-alpha) and interleukins (ILs). These inflammatory mediators correlate with altered thyroid hormones, contributing to non-thyroidal illness (NTI) post-surgery.

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Area of Science:

  • Endocrinology
  • Immunology
  • Surgical Physiology

Background:

  • Surgical stress can induce significant physiological changes.
  • Thyroid hormone levels often fluctuate after major operations.
  • The role of inflammatory cytokines in these hormonal shifts is not fully understood.

Purpose of the Study:

  • To investigate the relationship between cytokine release and thyroid hormone alterations during surgical stress.
  • To determine if cytokines contribute to the development of non-thyroidal illness (NTI) following major abdominal surgery.

Main Methods:

  • Studied 36 adult patients undergoing elective major abdominal operations.
  • Measured serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-8, IL-10, thyrotropin (TSH), free thyroxine (FT4), and triiodothyronine (T3).
  • Measurements were taken pre-surgery, immediately post-op, and on postoperative days 1 and 2.

Main Results:

  • Pro-inflammatory cytokines (TNF-alpha, IL-6, IL-8) peaked on postoperative day 1.
  • Interleukin-10 (IL-10) peaked immediately postoperatively.
  • Fourteen patients exhibited low T3 levels, indicative of NTI.
  • Significant negative correlations were observed between TNF-alpha, IL-6, IL-8 and T3/FT4 levels.

Conclusions:

  • Cytokine release plays a significant role in the thyroid hormone changes observed after major surgery.
  • These inflammatory mediators are implicated, at least partially, in the pathogenesis of non-thyroidal illness following surgical stress.