Международный эндокринологический журнал 1 (65) 2015

The morbidity of multidrug-resistant tuberculosis increases during last 10-15 years with 2 millions of cases more. The recovery of tuberculosis in multidrug-resistant patients is possible only in 60-70 % of cases and in patients with extensively drug-resistance - only in 20-30 % of cases. In this situation the capability of the body to form adequate immune answer to tuberculosis infection is very important. Systemic influence of the thyroid on every chain of antituberculosis immunity and antituberculosis outcomes is well-known. But thyroid can function only in condition of its normal supplying by selenium which is needed for iodination of thyroid hormones. The outcomes of chemotherapy in multidrug-resistant tuberculosis patients with compensated selenodeficiency were not previously studied.   

The main goal of the research is comparative study of the outcomes of antituberculosis chemotherapy in patients suffering from thyroid pathology with selenium deficiency and at compensative selenium therapy.

Materials and methods. Clinical investigations were performed in Kharkiv antituberculosis dispensary #1 during 2010-2014 years. In controlled investigation 60 patients with drug-resistant tuberculosis took place.  The selection of patient was done by occasion method. After indiscriminant screening of thyroid gland in 100 drug-resistant tuberculosis patients with diagnostic ultrasound apparatus SSF-240A  (Toshiba Medical Systems)   in 60 patients the pathology of echostructure or (and)changes of its volume was diagnosed, after that the screening was stopped. In most of patients (60%) diffused mosaic pathology like autoimmune thyroiditis prevailed.  The levels of free thyroxine, thyroid stimulating hormone, antibodies to thyroglobulin and thyreoperoxides were measured before and at the end of intensive phase of antituberculosis chemotherapy which lasted about 8 months by immune-enzyme method. Selenium was identified in blood by atomic absorption spectrometry using Zeeman background correction and palladium/ascorbinic acid chemical modification in the laboratory Synevo (Germany).

The drug-resistant tuberculosis patients with thyroid pathology were joint in two groups with 30 patients in each group. The patients of the main group received standardized antituberculosis chemotherapy and 100 mcg selenium nitric - cefacel (Cefax, Germany) a day. The patients of control group received standardized antituberculosis chemotherapy only.               

The results and the discussion. As a result of the study in both groups in average low-normal levels of free thyroxine and high-normal levels of thyroid stimulating hormones were determinate. No significant changes of antibodies level were diagnosed. The results showed the tendency of weakening of thyroid function in patients suffering drug-resistant tuberculosis with pathological echostructure of thyroid. It was also determinate than the level of selenium was low in both groups (56.66±6.89) mcg/l in the main group and (57.00±7.16) mcg/l in the control group in compare with the normal (74.0 – 139.0) mcg/l.  During the chemotherapy selenium level was restored. More significant restoration was watched in the main group in compare with the control (relatively 107.00±12.57 and 76.50±11.54) mcg/l.  In patients receiving selenium nitric thyroid function increased as can be estimated on the normal levels of thyroid and thyroid-stimulating hormones. But in control group thyroxine level decreased and thyroid-stimulating hormone significantly increased. The result demonstrated increasing of thyroid function under the action of antituberculosis drugs like ethionamide and PAS in the control and protective role of selenium for thyroid gland in the main group. Besides the efficacy of antituberculosis chemotherapy also were better in patients received selenium: intoxication was stopped earlier with 7 days, stopping of bacilli expelling was more significant (in 60% of patients) comparing with the control (52%) and healing of the cavitation also was more significant in the main group (33.33%) comparing with the control (23.33%).

Thus, timely finding of selenium deficiency and its compensation in drug-resistant tuberculosis patients with thyroid pathology increases the efficacy of antituberculosis chemotherapy. 

Conclusions:

1. Drug-resistant tuberculosis patients with thyroid pathology have clear selenium deficiency.

2. Thyroid function is lowered in drug-resistant tuberculosis patients with thyroid pathology and decreases of 8 months of chemotherapy.

3. The inclusion of selenium nitric in complex treatment of drug-resistant tuberculosis patient restores selenium deficiency and thyroid function and improves the results of antituberculosis chemotherapy.

4.  The results of the study allow recommending including cefacel in complex therapy of drug-resistant tuberculosis patients with thyroid pathology.