| Objectives: 1.To understand the Hashimoto's thyroiditis patients and Graves disease patients serum IL?17 and 25(0H)D level and the difference with normal children. 2.To study on the correlation between serum IL?17, 25(0H)D level and thyroid function(FT3, FT4, TSH) and thyroid associated antibodies(TRAb, TPOAb, TGAb) in children with Graves disease and Hashimoto's thyroiditis,and to explore the expression of IL?17 and 25(0H)D in children with Hashimoto's thyroiditis and Graves' disease occurrence, development process, and provide new thoughts for the treatment of two types of lesions. 3.To study on the correlation between serum IL?17 and 25(0H)D level in children with Graves disease and Hashimoto's thyroiditis,and to explore the relationship of the two in the pathogenesis of Hashimoto's thyroiditis and Graves disease. 4. To study the changes of serum IL?17 and 25(OH) D levels in the serum of patients with HT after treatment with normal thyroid function. As well as the correlation of thyroid function(FT3, FT4, TSH) and thyroid antibodies(TRAb, TPOAb, TGAb), and further explore the intrinsic link between IL?17 and 25(OH) D and HT.Materials and Method: 1.From September 2014 to September 2015, 78 children with HT and GD without treatment were selected in pediatric endocrine clinic of General Hospital Affiliated to Tianjin Medical University. Among them, 32 children with HT as HT group, including 7 boys and 25 girls; GD in 46 children with GD group, including 12 boys and 34 girls. All patients were initially diagnosed with AITD and untreated. GD diagnostic criteria:(1)GD diagnostic criteria for clinical symptoms and signs of hyperthyroidism.(2)The diffuse enlargement of the thyroid gland(palpation and ultrasound confirmed), a few cases can be no goiter.(3)Serum TSH decreased and thyroid hormone increased.(4)The exophthalmos and other invasive eye syndrome.(5) The pretibial myxedema.(6) The thyroid TSH receptor antibody(TRAb or TSAb). The above standard, first, the second and the third for the diagnosis of essential condition, four, five and six for the diagnosis of auxiliary conditions. HT diagnostic criteria:(1) diffuse goiter.(2) Serum thyroid peroxidase antibody(TPOAb) and thyroid globulin antibody(Tg Ab) were significantly increased. All children with no other autoimmune diseases or other history of thyroid disease, allergy history, without recent infection, without serious liver and kidney function not congruent, recently did not take drugs affecting bone metabolism. Another 40 children were selected as healthy control group, including 14 boys and 26 girls. There was no significant difference in age and sex ratio between the 3 groups. All the children were extracted from the elbow vein in the morning, and the blood was separated by centrifugation, and the titer of TRAb, TPOAb and TGAb were determined respectively, the titer of serum IL?17, 25(OH) D was determined by ELISA method. Using statistical software package SPSS 20 analysis of the measured data, compared with the GD group and HT group, between the GD group and the normal group as well as between the HT group and the normal group, the differences between the indicators and the correlation. 2. Clinical data of 32 children with HT who were treated with L?T4 replacement therapy and follow?up data were collected.TRAb, TPOAb, TGAb, FT3, FT4, TSH, IL?17, 25(OH) D were measured in all patients with normal thyroid function. To analyze the changes of BMI, heart rate and thyroid volume before and after treatment, and to analyze the differences and mutual relations of different laboratory indexes before and after treatment.Results: 1. The serum levels of 25(OH) D in GD group and HT group were lower than those in normal group(all P < 0.05), and the proportion of vitamin D deficiency(<10ng/ml) and leck(10?20ng/ml) in the two group and normal group was significantly higher than that in the normal group(all P < 0.05). The serum levels of IL?17 in GD group and HT group were higher than those in normal group(all P < 0.05). There was no significant difference between GD group and HT group. 2. The serum levels of 25(OH) D/ IL?17 were not correlated with FT4 and TSH, and FT3 in the group GD and group HT. GD group with 25(OH) d levels and TGAb, TRAb level was negatively correlated r=?0.37, P < 0.05; r=?0.44, P < 0.05), and TPOAb no correlation; the level of IL?17 TPOAb, TRAb levels were positively correlated(r = 0.41, P < 0.05; r = 0.56, P = 0.05), and TGAb no correlation. HT group with 25(OH) d levels and TPOAb and TRAb levels was negatively correlated(on the contrary(P < 0.05). R=?0.37, P < 0.05), and TGAb no correlation; IL?17 and TGAb and TPOAb and TRAb levels were positively correlated(r = 0.59, P < 0.05; r = 0.42, P < 0.05; r = 0.28, P < 0.05). 3. In Group HT, the level of 25(0H)D had negative correlation with TPO?Ab?TR?Ab(r=?0.55,P<0.05; r=?0.37,P<0.05)but had no correlation with TG?Ab; the level of IL?17 had positive correlation with TPO?Ab?TG?Ab?TR?Ab(r=0.59,P<0.05; r=0.42,P<0.05; r=0.28,P<0.05) 4. The serum levels of 25(OH) D and IL?17 were not correlated with the levels of FT3, FT4 and TSH in the patients with HT group after treatment,.Serum 25(OH) D levels and TPO AB, TR AB level was negatively correlated r=?0.5, P < 0.05; r = ?0.39, P < 0.05), and TG AB no correlation; IL?17 and TGAb, TG AB, TR AB level were positively correlated(0.58, P < 0.05; r = 0.45, P < 0.05; r = 0.27, P < 0.05). Serum level of 25(0H) D was negatively correlated with the level of IL?17(r=?0.46, P<0.05)Conclusions: Compared with the normal group, GD and HT patients had low vitamin D levels and high levels of IL?17. Vitamin D and IL?17 may be involved in the pathogenesis of GD and HT in children, and they are closely related to each other. Serum low vitamin D levels and high IL?17 involvement in AITD pathogenesis is not dependent on thyroid function, but may be associated with autoimmune. |
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