Apoptosis and proliferation of thyrosites as predictors of postoperative outcomes in patients operated on the reason of diffuse toxic goiter

Abstract

Currently, according to federal recommendations, patients with diffuse toxic goiter in the absence of remission of the disease performed extirpation of the thyroid gland. The results of the study of the effect of apoptosis and proliferation proteins in thyrocytes (Ki-67, Bcl-2, Bax, Fas-L, caspase-8) on postoperative outcomes in patients operated on for diffuse toxic goiter. A positive correlation was found between the concentration of antibodies to the thyroid-stimulating hormone receptor with the preoperative thyroid volume and the level of the anti-apoptotic Bcl-2 protein, as well as the inverse relationship with the area of the follicles, which may reflect a slowing of apoptosis and an increase in proliferative activity Thyroid cells. In patients with diffuse toxic goiter with postoperative relapse of thyrotoxicosis, high activity of the Bcl-2 apoptosis suppressor protein and the violation of the Bcl-2/Bax ratio were established. In patients with postoperative thyrotoxicosis, a significantly greater expression of anti-apoptotic Bcl-2 protein was found, 3,13±0,29%, compared with patients who developed hypothyroidism after surgery of 1,24±0,29% and who maintained euthyroidism – 1,36±0,25%. There was also an inverse correlation between the level of antibodies to thyreperoxidase and anti-apoptotic protein Bcl-2, as well as the Ki-67 proliferation marker. When carrying out discriminant analysis between groups with postoperative hypothyroidism and thyrotoxicosis, the main variable was the anti-apoptotic Bcl-2 protein and between the groups with postoperative euthyroidism and thyrotoxicosis – the Ki67 proliferation protein. With a Bcl-2 value of more than 2.19 and a proliferation protein of Ki-67 greater than 1,059, the probability of postoperative thyrotoxicosis is 87,5% for each.