الفهرس 
TitleOnly 14 pages are availabe for public view
 |  | from | 106 |  |  |
| | | from | 106 | | |
Abstract
Hashimoto’s thyroiditis is a part of the spectrum of chronic autoimmune thyroid diseases caused by an interaction between environmental and genetic factors. It is considered the most common cause of hypothyroidism in areas of iodine sufficiency as in Egypt. Hashimoto’s thyroiditis is associated with thyroid autoantibodies production, the most common are thyroid peroxidase antibodies (anti-TPO) and thyroglobulin antibodies (Tg-Ab) with various degrees of thyroid hypofunction.
Enteric protozoa constitute a diverse group of unicellular microparasites colonizing the intestinal track of high vertebrate hosts including humans. They are transmitted through ingestion of cyst/ oocysts in contaminated food or water or through person to person route. Several species of protozoa are associated with gastrointestinal illness in humans worldwide. Among them, Blastocystis hominis.
Blastocystis hominis is the most common intestinal protozoan isolated in humans, it has a wide geographic distribution with higher prevalence in developing countries. Although this parasite in most cases remain asymptomatic . The pathogenic potential of B. hominis remains controversial. B. hominis can invade the lamina propria, the submucosa and even the muscle layers.
Blastocystis hominis infection is associated with various diseases and it has been demonstrated that B. hominis has the ability to modulate immune response.
Th17 cells and their hallmark cytokine IL-17 were identified as major contributing factors in the pathogenesis of HT. The roles of Th17 cells in inflammatory bowel disease (IBD) and Crohn’s disease (CD) are more complicated than in other autoimmune diseases. The presence of lymphocytic infiltrates in the inflamed colonic mucosa has shown the involvement of IL-17 in the pathogenesis of inflammatory bowel disease (IBD). Furthermore, elevated serum IL-17 concentration was found in patients with active IBD in comparison to healthy individuals.
Summary, Conclusion & Recommendations
66
The present work aimed to determine the level of serum IL17 in Hashimoto’s thyroiditis patients with and without Blastocystis hominis infection and the effect of Blastocystis hominis treatment on IL17 serum level and clinical course of thyroiditis. The study protocol was approved by the research ethics committee of the medical research institute
A cross sectional study was carried out on sixty patient aged (19-57years) with Hashimoto’s thyroiditis including 20 with Blastocystis hominis infection from Endocrinology clinic in the hospital of the University of Alexandria to detect Blastocystis hominis infection and Hashimoto’s thyroiditis disease after obtaining informed consent.
Medical data of individuals were collected through an interviewing questionnaire. A single fresh stool sample was collected from each individual and examined using sedimentation concentration technique followed by examination of the precipitate by saline and lugo’s iodine wet mount to detect protozoan cysts and helminths eggs or larvae. Stool samples of Blastocystis positive patients were further examined using Kato-Katz technique to exclude associated helminthic infections.
IL17 level was estimated using ELISA kit in all patients and controls. And Blastocystis infected patients (group II) were treated with nitazoxanide in a dose of 200-mg twice daily for 3 days. Follow up was performed three weeks after treatment, another stool sample was collected from each treated patient and examined using the same techniques describe above. IL17 level was re-estimated using the same ELISA assay.
After nitazoxanide treatment, IL17 level among Blastocystis infected patients (group II) ranged from 1.90-10.20 pg/ml and the median value was slightly decreased compared to the before treatment value ( 6.4-6.7pg/ml).So, there was a significant difference in the level of IL17 in group II before and after treatment of Blastocystis.
Summary, Conclusion & Recommendations
67
6.2 Conclusion
Serum IL-17 is involved in the induction and development of Hashimoto’s thyroiditis.
Patients with Hashimoto’s thyroiditis infected with Blastocystis hominis showed a significant high level of serum IL-17, suggesting a potential role of Blastocystis hominis infection in the development of Hashimoto’s thyroiditis.
Nitazoxanide is a good candidate for the treatment of blastocystosis in patients.
Blastocystis hominis eradication in patients with Hashimoto’s thyroiditis resulted in a significant reduction in serum IL-17 level as well as in the levels of anti-TPO and TSH. Hence, treating Blastocystis hominis infection can ameliorate Hashimoto’s thyroiditis and even stop its progression.
6.3 Recommendation
Further studies using large numbers of patients are required to confirm improving Hashimoto’s thyroiditis after Blastocystis hominis infection treatment.
A study is needed to assess changes in thyroid gland using ultra sound.
Future research is needed to assess whether inflammatory changes and elevated IL17 level are related to infection with certain Blastocystis hominis spp.