Bobrova I. . Clinical and pathogenetic aspects of cytokine-induced thyropathy in the presence of the chronic hepatitis C and their correction

The thesis presents the results of a comprehensive study related to clinical and pathogenetic aspects of the chronic hepatitis C (НCV), whose antiviral therapy was complicated due to cytokine-induced thyropathy (CIT). The thesis states specific features in production and kinetics of IL-1?, IL-6, IL-8, TNF-?, IL-1Pa, IL-4, IL-10, ANA, Ab IFN-?, IgE, indicators of T- and B-immunity before and during therapy based on the state of the thyroid gland. Thyroid disorders developed in 22,37% of patients, and they were 8 times more common in women. The most common thyropathy was the early one, which developed in women of reproductive age, and proceeded with biphasic disfunction and autoimmune component. Based on results of the complex characterization it has been determined that the predictors of CIT development in the presence of the HCV are: female gender, any initial echopathology in the thyroid gland, increased levels of antithyroid antibodies, and TNF - IL-1Ra (±IL-8), the presence of the homozygous genotype C/C 781 IL-8 gene. The following may be considered as pathogenic factors: activation of cytokine cascade, hyper reactivity of the immunity B-cell unit with increased production of autoantibodies, Ig E, and ±NK-cells. The following was developed: the diagnostics algorithm, the panel of "alarm" symptoms, classification based on the development timing, nature of laboratory changes, clinical course, etc. The pharmacological correction methods for cytokine-induced hyperthyroidism and the CIT phased support procedure depending on the disorder were substantiated