Journal of Disease and Global Health

Background: Graves’ disease (GD) is a leading autoimmune endocrine disorder characterised by hyperthyroidism and systemic inflammation. It remains the leading cause of hyperthyroidism worldwide, particularly among women aged 30 to 60 years.

Aim: This study evaluated serum thyroid hormones and selected inflammatory biomarkers among hyperthyroid patients with and without Graves’ orbitopathy (GO) in Orlu, Imo State, Nigeria.

Methodology: The cross-sectional study was conducted with a total of 148 Graves disease patients and controls, comprising 74 clinically diagnosed Graves patients (37 with GO and 37 without GO) and 74 apparently healthy, age-matched controls. Serum triiodothyronine (T₃), thyroxine (T₄), thyroid-stimulating hormone (TSH), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-23 (IL-23), interferon-gamma (IFN-γ), and tumour necrosis factor-alpha (TNF-α) were measured using ELISA techniques. Data was analysed using SPSS version 21.0, and statistical significance was set at P < 0.05.

Result: Results revealed significantly elevated T₃ and T₄ levels with concomitant suppression of TSH in GD patients compared with controls (P < 0.001). Inflammatory markers (ESR, CRP, IL-23, IFN-γ, and TNF-α) were markedly higher in hyperthyroid subjects, with more pronounced elevations among those with GO. ESR and CRP values were significantly increased in GD patients (32.7 ± 8.3 mm/hr and 20.9 ± 8.6 mg/L, respectively) relative to controls (12.6 ± 4.4 mm/hr and 5.8 ± 2.7 mg/L). Similarly, IL-23, IFN-γ, and TNF-α levels were substantially elevated in GO subjects (IL-23: 49.3 ± 10.1 pg/mL; IFN-γ: 13.8 ± 4.6 pg/mL; TNF-α: 20.1 ± 3.8 pg/mL) compared with non-GO subjects (P < 0.001). Pearson’s correlation analyses demonstrated significant positive associations between TSH and IL-23, IFN-γ, and TNF-α in male GD subjects. while female subjects showed mixed correlations between TSH and inflammatory markers, suggesting sex-related immunological differences.

Conclusion: This study demonstrates that Graves’ disease is associated with a profound increase in thyroid hormones and systemic inflammation, given the levels of thyroid hormones and cytokines assayed. These findings highlight the need for a targeted therapeutic approach, integrating anti-inflammatory agents in GD management for improved disease outcome.