INTRODUCTION:

Thyroid disease include hyperthyroidism and hypothyroidism, one of the autoimmune disease responsible for hyperthyroidism Graves disease is the most common cause of hyperthyroidism, and it occurs in women about 4-5 one time more than in men.

The cause of the disease is due to the formation of Immunoglobulin –G(IgG) it is called a thyroid –stimulating hormone receptor (TSH-R)-stimulating antibody, which binds to the same membrane receptors that it interacts with thyroid stimulating hormone in the follicular cells, causing stimulation of these cells, then increase in the secretion of thyroid hormones thyroxine T4 and triiodothyronine T3.¹, or hyperthyroidism sometimes occurs when thyroid hormones are taken in the form of drugs, especially medicines containing on iodine as Amiodarone these medicines lead to a condition is know drug poisoning^2,3. also carbimazole is anti-hyperthyroidism drug by reducing the intake of iodine and formation of diodotyrosine which prevents coupling of thyroid peroxidase enzyme and iodanation of tyrosine residues on thyroglobulin and reduce production of thyroid hormone⁴, the methods of treatment of Graves disease are hostile thyroid medication, radioiodine and surgery⁵, thats why the good knowledge and a wareness towards increases the patient compliance toward medication and regular follow up⁶. TSH levels are useful in evaluation of thyroid function because small changes in free thyroid hormone levels lead to greater changes in TSH⁷,while Hashimatos disease is one of the most common causes of hypothyroidism and occurs in women about 5-10 ones more than in men and is due to several reasons, including antibody that inhibit thyroid –stimulating hormone receptors (TSH-R Ab), Thyroglobulin antibodies (Tg), Thyroid peroxidase antibodies(TPO)^8,9, also Hypothyroidism can occur post-surgery or after treatment with radioactive iodine, as high doses of iodine cause damage to the thyroid tissue or this deficiency of iodine is due to nutritional reasons^2,10. also there was a significant relationship between obesity and hypothyroidism¹¹, the thyroid peroxidase enzyme is also called thyroperoxidase, which participates in the formation of thyroid hormones, the gene for it is located on the chromosome 2p25,it consists of 933 amino acid in the form homodimer, its molecular weight ( 107 KD), oxidizes inorganic iodide to iodine, in the presence of hydrogen peroxide, tyrosine is iodized in thyroglobulin, then the enzyme works on the formation of thyroid hormones by conjugating pro-tyrosine molecules with the presence of NADPH molecules as energy^12,13.

AIM OF RESEARCHED:

Since there were a little previous studies In Iraq about thyroid peroxidase (TPO)and its relation with thyroid diseases, especially in patients with hyperthyroidism and hypothyroidism disease, so it was proposed to study it mechansium of action in patients and its relationship with the measured biochemical parameters.

MATERIALS AND METHODS:

Experimental:

(60) blood samples were collected from thyroid patients, (30)samples for both hyperthyroidism and hypothyroidism, their ages between (15-75)year, also (30) blood samples were collected from healthy people from Ibn-Sina Teaching Hospital, After the blood serum was isolated from the samples, it was used to estimate the following some biochemical parameters.

TPOenzyme-was estimated by using BT LAB Bioassay Technology Laboratory kit(China)by enzyme linked immunoassay ELISA technique¹⁴ .

T3–was determined by using BIOLABO kit(Farance)¹⁵.

T4-was determined by using VEDA.LAB.kit(France)¹⁵.

TSH-was determined by using VEDA.LAB.kit(France) ¹⁶.

Glucose- Was determined by using BIOLABO kit(France)^17,18.

Vitamin D- was determined by using BIOMERIEUX kit(Farance)¹⁹.

Calcium-was determined by using BIOLABO kit (Farance)²⁰.

Uric acid-was determined by using BIOLABO kit (Farance)²¹.

Albumin-was determined by using BIOLABO kit (Farance)²².

Alkaline phosphatase enzyme- was determined by using BIOLABO kit (Farance)^23,24.

Transaminase enzyme GOT and GPT-were determined by using BIOLABO kit (Farance)^24,25.

Data analysis:

The obtained data were analysed by using test for normality (shapiri-wilk),test for hypotheses (kruskal test and dunse) to found the mean and standard deviation, when the p-Value ≤ 0.05 was assumed statistically significant also the relationship between the thyroid peroxidase (TPO) enzyme and the measured parameters was determined by finding the linear correlation coefficient²⁶.

RESULTS AND DISCUSSION:

The activity of TPO enzyme in hyperthyroidism and hypothyroidism disease patients compared with control group:

The result showed that the normal activity of TPO enzyme was (33.9±18.9 Iu/ml)in control group, the result also elucidated that the activity of the TPO enzyme was a significant increase (273.9±235.1 Iu/ml)in hypothyroidism patients, which is higher than its effectiveness in patients with hyperthyroidism, as it was (112.63 ±69.5 IU/ml)compared with control group,these results are in agreement with the findings of a study done on patients with thyroid disorders²⁷.

Figure 1: Thyroid peroxidase (TPO) activity in hyperthyroidisum and hypothyroidisim compered with control group

Some clinical parameter concentration in hyperthyroidism, hypothyroidism compared with control group:

The results in table (1) showed a significant increase in T3, non significant increase inT4,decrase in TSH concentration in hyperthyroidism patients, while a significant decrease in T4 and non significant decrease in T3,significant increase in TSH concentration in hypothyroidism patients compared with control group, these results are in agreement with the researchers reported²⁸. While the results showed significant increase in glucose concentration in both hypothyroidism and hyperthyroidism patients compared to healthy controls, also a significant decrease in vitamin D and calcium was observed in both hypothyroidism and hyperthyroidism patients compared to healthy controls, the reason may be due to increased skeletal turnover, this stat is assocated with malabsorption of calcium and increased bone resorption²⁹, and thyroid hormones (TH)have intense effect on bone strength and mineral metabolism³⁰, also vitamin D deficiency may promote the production of various cytokines,which causes the development of autoimmune thyroiditis and leads to decreased thyroid function^31,vitamin D also plays a major role in maintaining the oral health, mineral metabolism, formation bone, calcium cycle^32,33 . table (1)also shows anon significant increase in uric acid because decrease glomerular filtration rate (GFR)and that leading to low excretion of uric acid in the kidney³⁴, and non significant decrease in albumin, the results also shows a significant increase in ALP, GOT, GPT enzymes in hyperthyroidism while a significant increase in ALP enzyme and a non significant increase in GOT, GPT in hypothyroidism, this may be due to alteration of liver function parameters in the current study, and this may indicate the change in the rate of bone turnover in hypothyroid and hyperthyroid patients, also deficiency in vitamin D have elevated levels of ALP enzyme³⁵. also activity of ALP is dropped significantly in serum indicate that bone resorption occurs at lower rate as result of decline thyroid hormones³⁶ .

Table 1. Some clinical parameters concentration in control and hyperthyroidism, hypothyroidism patients

Clinical Parameters	Control Group	Hyperthyroidism	Hypothyroidism
T3 Iu/L	0.91 + 0.45	3.21** + 0.8	0.52 + 0.42
T4 Iu/L	6.74 + 1.44	8.57 + 2.9	3.003** + 1.26
TSH Iu/L	2.43 +1.3	0.43** + 0.79	5.6** + 2.6
Glucose mg/dl	82.2 + 9.0	123.48** + 53.6	119.23** + 32.9
Vit. D ng/dl	41.4 + 11.96	29.11** + 12.5	18.41** + 10.6
Calcium mg/dl	9.08 + 0.7	8.27** + 1.62	8.17** + 1.08
Uric acid mg/dl	6.45 + 1.61	7.7 + 1.89	8.03 + 3.18
Albumin mg/dl	4.37 + 0.5	4.31 + 0.3	4.36 + 0.69
ALP Iu/L	65.7 + 67.1	158.2** + 36.4	100.81** + 41.8
GOT Iu/L	15.9 + 3.2	39.37** + 6.9	16.67 + 3.03
GPT Iu/L	16.52 + 2.07	47.56** + 9.3	18.22 + 3.84

Significant difference at **p<0.01

Correlation between TPO activity and some clinical parameters in hyperthyroidism, hypothyroidism patient comparing to control group:

The result in table (2) showed that TPO activity had a negative significant correlation with GPT enzyme in hyperthyroidism, this result is in agreement with the research findings³⁷as thyroid peroxidase (TPO) enzyme was more likly to be associated with hepatic dysfunction and hyperthyroidism has been known to be associated with abnormalities of serum liver chemistry, also TPO enzyme had a negative significant correlation with vitamin D, calcium in hypothyroidism, this result is consistent with the researchers reported in^38,39there is negative significant correlation could be established between vitamin D levels and anti-TPO levels in anti-TPO positive patients,also in thyrotoxic patients may be directly proportional to vitamin D deficiency, negative calcium and bone mineral density. while the result in table (2) showed that TPO activity had a non significant correlation with the rest of the biochemical parameters.

Table (2): Correlation between TPO activity enzyme and some clinical parameters in hyperthyroidism, hypothyroidism patient compared with control group

Clinical parameters	Control Group r- value	Hyperthyroidism r- value	Hypothyroidism r- value
T3	- 0.138	0.038	0.086
T4	0.09	0.125	- 0.094
TSH	- 0.18	0.04	- 0.068
Glucose	- 0.04	- 0.177	0.261
Vit. D	- 0.004	0.152	- 0.441*
Calcium	0.033	0.086	- 0.363*
Uric acid	- 0.103	- 0.23	0.156
Albumin	0.046	0.08	- 0.186
ALP	0.097	0.019	0.195
GOT	- 0.038	- 0.255	0.096
GPT	- 0.128	- 0.364*	0.188

* Correlation is significant at the 0.05 level

ACKNOWLEDGMENTS:

Iwould like to extend my thanks and report to the University of Mosul for providing me with all the necessary facilities to complete this research .

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Received on 27.02.2022 Modified on 12.04.2022

Research J. Pharm. and Tech 2023; 16(1):205-208.

DOI: 10.52711/0974-360X.2023.00038