Serum concentrations of interleukin (IL-)1alpha, 1beta, 6 and tumor necrosis factor (TNF-) alpha in patients with thyroid eye disease (TED).

Serum proinflamatory cytokines were found to be altered in Graves disease (GD) and in TED. Serum values of IL1alpha, IL-1beta, IL-6, TNF-alpha were assessed in 22 patients with TED before and after treatment (aged 46.82 +/- 12.47, M:F=16:6). Free thyroxin was high, TSH low, thyroid ultrasound showed diffuse thyroid enlargement, treatment with antithyroid drugs propylthyouracil (PTU) or methymasol (MMI) resulted in clinical and hormonal remission. Several months after the initiation of the signs of hyperthyroidism, a progression in the ophthalmopathy was observed (Hertel up to 25 mm: normal 15-17 mm) while patients were clinically and hormonally euthyroid. Blood was collected in euthyroid state (with TED signs present, before corticosteroid therapy (CS) treatment) and after 3 months of treatment (patients without TED and without TED treatment). CS resulted in response of 8/22 patients. Ophthalmic irradiation (01) given with CS therapy, resulted in a response in twelve patients (12/12). Lack of response to CS treatment, with rapid increase in proptosis, and loss of visual acuity prompted ophthalmic decompression (OD) in two patients. Both recovered visual acuity, while proptosis fell under 25 mm Hertel. The control group had 29 persons (aged 51.86 +/-10.52, M:F = 16:13). A significant difference was found in the serum levels of IL-1alpha between the groups of controls (0.74+/-0.55 pg/ml) and patients before treatment (1.85 +/- 1.85 pg/ml; p < 0.005). This difference further increased after treatment to 5.08 +/- 4.42 pg/ml (p < 0.05). Serum IL-1beta was higher in patients before treatment (0.36 +/- 0.15 pg/ml) in comparison with controls (0.24 +/- 0.43 pg/ml; statistically not significant--NS), and its concentrations remained unchanged after treatment (0.39 +/- 0.18 pg/ml; NS). IL-6 also had lower concentrations in patients at the start of the treatment (1.28 +/- 0.92; controls 1.72 +/- 1.9 pg/ml; NS). After the completion of TED treatment its concentration raised to 2.07 +/- 1.82 pg/ml (higher than the pretreatment; NS). For patients with low Clinical Activity Score (CAS) scores (1-5) there was no change in IL-6 concentrations before (1.03+/-o.64 pg/ml) and after treatment (1.07 +/- 0.63 pg/ml). Patients with higher CAS scores (6-10) had a change in IL-6 levels (from 1.32+/-1.00 to 2.67 +/- 4.84; p > 0.05). In addition, patients with pathological VEP had no changes in IL-6 (from 0.93 +/- 0.53 to 0.97 +/- 0.32 pg/ml), while patients with normal VEP had increased IL-6 serum concentrations (1.36 +/- 0.98 to 2.32 +/- 4.17 pg/ ml; NS). No stimulatory effect of IL-1beta on IL-6 was observed: IL-1beta was unchanged while IL-6 levels were increased after treatment. In general, when compared to controls TNF-alpha was twofold lower in patients than in the controls (0.18 +/- 0.034 and 0.34 +/- 0.41 pg/ml respectively; p < 0.05). In addition, serum TNF-alpha concentration did not change with treatment (0.18 +/- 0.03 pg/ml; p < 0.05). Increasing serum concentrations of TNF-alpha before and after treatment were associated with more severe forms of TED (treated with OD and O1 with CS). Smoking did not alter the serum concentrations of cytokines.