Research Article
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Evaluation of hematologic inflammatory markers in Graves’ disease

Year 2023, Volume: 8 Issue: 5, 112 - 117, 12.10.2023

Hasan Atlı Ramazan Dayanan

https://doi.org/10.22391/fppc.1322984

Abstract

Introduction: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) have been used as new inflammatory markers in certain autoimmune diseases to assess the severity of inflammation. The current study aimed to evaluate the changes in neutrophil and lymphocyte series in hyperthyroid patients and to investigate whether NLR, PLR, and SII may be markers of inflammation.
Methods: This cross-sectional study was conducted with 207 Graves’ patients and 120 healthy controls between 2018-2022 years. Hematologic parameters, thyroid function tests, age and gender were recorded. The NLR, PLR and SII values of all subjects were calculated. Firstly, groups were composed as Graves' group and participants without thyroid disorder as control group. Secondly, Graves' patients composed as two groups before treatment and after antithyroid treatment. These groups were compared with each other in terms of descriptive data and hematological parameters.
Results: The patient and control groups were similar in terms of gender (p=0.522) and age (p=0.051). Graves’ patients had a significantly lower NLR than the control group (p=0.004). There was no significant difference between the groups in terms of PLR (p=0.120) and SII (p=0.577). Patients’ baseline TSH-receptor antibodies (TRAb) levels had a significant positive correlation with fT3 (r:0.283, p<0.001), fT4 (r:0.252, p<0.001) and Thyroid stimulating immunoglobulin (TSI) (r:0.673, p<0.001). There was no significant correlation between TRAb and TSI levels, inflammatory markers, and hematological parameters.
Conclusions: Graves’ patients had lower NLR compared to the control group. The patient and control groups did not have a significant difference with regard to PLR and SII. Thyroid autoantibody levels and inflammatory markers did not have a significant correlation.
Keywords: Hyperthyroidism, inflammation, neutrophils, lymphocytes

Keywords

Hyperthyroidism inflammation neutrophils lymphocytes

Ethical Statement

The study was approved by Batman Training and Research Hospital Ethics Committee (Decision: 356/21.06.2023). The research was conducted in accordance with Good Clinical Practice (Declaration of Helsinki of 1975). Written consent form was obtained from all participants.

Thanks

We would like to thank to the Society of Endocrinology and Metabolism of Turkey.

References

  • 1. Smith TJ, Hegedüs L. Graves' Disease. N Engl J Med. 2016;375(16):1552-65. https://doi.org/10.1056/nejmra1510030
  • 2. Ehlers M, Schott M, Allelein S. Graves' disease in clinical perspective. Front Biosci 2019;24(1):35-47. https://doi.org/10.2741/4708
  • 3. Antonelli A, Ferrari SM, Ragusa F, Elia G, Paparo SR, Ruffilli I, et al. Graves' disease: Epidemiology, genetic and environmental risk factors and viruses. Best Pract Res Clin Endocrinol Metab. 2020;34(1):101387. https://doi.org/10.1016/j.beem.2020.101387
  • 4. He M, Wang Y, Wang J, Sui J, Ding X, Chen Z, et al. The potential markers involved in newly diagnosed graves' disease and the development of active graves' orbitopathy. Cytokine. 2020;127:154998. https://doi.org/10.1016/j.cyto.2020.154998
  • 5. Wang Y, Chen Z, Wang T, Guo H, Liu Y, Dang N, et al. A novel CD4+ CTL subtype characterized by chemotaxis and inflammation is involved in the pathogenesis of graves' orbitopathy. Cell Mol Immunol. 2021;18(3):735-5. https://doi.org/10.1038/s41423-020-00615-2
  • 6. Celik T. Neutrophil-to-lymphocyte ratio in thyroid ophthalmopathy. Bratisl Lek Listy. 2017;118(8):495-98. https://doi.org/10.4149/bll_2017_095
  • 7. Yuksel N, Saritas O, Yuksel E. Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe graves' ophthalmopathy. Int Ophthalmol. 2023;43:3355–62. https://doi.org/10.1007/s10792-023-02742-x
  • 8. Dagdeviren M, Akkan T, Yapar D, Karakaya S, Dagdeviren T, Ertugrul D, et al. Can neutrophil/lymphocyte ratio be used as an indicator of inflammation in patients with hyperthyroidism? J Med Biochem. 2020;39(1):7-12. https://doi.org/10.2478/jomb-2019-0004
  • 9. Szydełko J, Litwińczuk M, Szydełko M, Matyjaszek-Matuszek B. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in relation to clinical parameters and smoking status in patients with graves' orbitopathy-novel insight into old tests. J Clin Med. 2020;9(10):3111. https://doi.org/10.3390/jcm9103111
  • 10. Turan E. Evaluation of neutrophil-to-lymphocyte ratio and hematologic parameters in patients with graves' disease. Bratisl Lek Listy. 2019;120(6):476-80. https://doi.org/10.4149/bll_2019_076
  • 11. Dorgalaleh A, Mahmoodi M, Varmaghani B, Kiani Node F, Saeeidi Kia O, Alizadeh Sh, et al. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol. 2013;3(2):73-7.
  • 12. Aggarwal N, Tee SA, Saqib W, Fretwell T, Summerfield GP, Razvi S. Treatment of hyperthyroidism with antithyroid drugs corrects mild neutropenia in graves' disease. Clin Endocrinol (Oxf). 2016;85(6):949-53. https://doi.org/10.1111/cen.13133
  • 13. Scappaticcio L, Maiorino MI, Maio A, Esposito K, Bellastella G. Neutropenia in patients with hyperthyroidism: Systematic review and meta-analysis. Clin Endocrinol (Oxf). 2021;94(3):473-83. https://doi.org/10.1111/cen.14313
  • 14. Shekhda KM. The association of hyperthyroidism and immune thrombocytopenia: Are we still missing something? Ci Ji Yi Xue Za Zhi. 2018;30(3):188-90. https://doi.org/10.4103/tcmj.tcmj_139_17
  • 15. Ren X, Meng Z, Liu M, Zhu M, He Q, Zhang Q, et al. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine (Baltimore). 2016;95(40):e4573. https://doi.org/10.1097/md.0000000000004573
  • 16. Marazuela M. Lymphocyte traffic and homing in autoimmune thyroid disorders. Eur J Endocrinol. 1999;140(4):287-90. https://doi.org/10.1530/eje.0.1400287
  • 17. Tuli G, Munarin J, Mazzucco B, Matarazzo P, de Sanctis L. Lymphocyte population in peripheral blood in children and adolescents with graves disease. Potential predictive tool for severity of the disease. Endocrine. 2022;77(2):319-4. https://doi.org/10.1007/s12020-022-03088-7
  • 18. Cheng CW, Fang WF, Tang KT, Lin JD. Serum interferon levels associated with the disease activity in women with overt graves' disease. Cytokine. 2021;138:155353. https://doi.org/10.1016/j.cyto.2020.155353
  • 19. Kim M, Kim BH, Jang MH, Kim JM, Kim EH, Jeon YK, et al. High neutrophil-to-lymphocyte ratio is associated with relapse in graves' disease after antithyroid drug therapy. Endocrine. 2020;67(2):406-11. https://doi.org/10.1007/s12020-019-02137-y
  • 20. Zhang X, Han C, Wang H, Sun X, Dou X, He X, et al. The correlation of the neutrophil-lymphocyte ratio to clinical and imaging parameters in patients with thyroid eye disease. Endocr Connect. 2022;11(11):e220260. https://doi.org/10.1530/ec-22-0260
  • 21. Keskin C, Dilekci EN, Uc ZA, Cengiz D, Duran C. Can the systemic immune-inflammation index be used as a novel diagnostic tool in the diagnosis of subacute thyroiditis? Biomark Med. 2022;16(10):791-97. https://doi.org/10.2217/bmm-2022-0095
  • 22. Ciftel S, Tuzun Z. Could the systemic immune inflammation index predict diagnosis, recovery time, hypothyroidism, and recurrence rates in subacute thyroiditis? Int J Gen Med. 2023;16:1375-82. https://doi.org/10.2147/ijgm.s406724
  • 23. Alay M, Sonmez GM, Yildiz S. Evaluation of neutrophil-to-lymphocyte ratio and mean platelet volume in patients with hyperthyroidism. Eastern J Med. 2020;25(3):388-92. https://dx.doi.org/10.5505/ejm.2020.79037
  • 24. Taskaldiran I, Omma T, Onder CE, Firat SN, Koc G, Kilic MK, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-tolymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci. 2019;49(6):1687-92. https://doi.org/10.3906/sag-1901-116

Graves hastalığında hematolojik inflamatuar belirteçlerin değerlendirilmesi

Year 2023, Volume: 8 Issue: 5, 112 - 117, 12.10.2023

Hasan Atlı Ramazan Dayanan

https://doi.org/10.22391/fppc.1322984

Abstract

Giriş: Nötrofil-lenfosit oranı (NLO), platelet-lenfosit oranı (PLO) ve sistemik immün inflamasyon indeksi (SII), bazı otoimmün hastalıklarda inflamasyonun şiddetini değerlendirmek için yeni inflamatuar belirteçler olarak kullanılmıştır. Bu çalışma, hipertiroidi hastalarında nötrofil ve lenfosit serilerindeki değişiklikleri değerlendirmeyi ve NLO, PLO ve SII'nin inflamasyon belirteçleri olup olmadığını araştırmayı amaçladı.
Yöntem: Bu kesitsel çalışma, 2018-2022 yılları arasında 207 Graves hastası ve 120 sağlıklı kontrol ile yürütülmüştür. Hastalarin hematolojik parametreleri, tiroid fonksiyon testleri, yaş ve cinsiyetleri kaydedildi. NLO (nötrofil/lenfosit), PLO (platelet/lenfosit) ve SII hesaplandı. Öncelikle olgular Graves grubu ve tiroid hastalığı olmayan sağlıklı kontrol grubu olarak ikiye ayrıldı. İkinci olarak, Graves hastaları tedavi öncesi ve antitiroid tedavisi sonrası olmak üzere iki grup oluşturdu. Bu gruplar tanımlayıcı veriler ve hematolojik parametreler açısından birbirleriyle karşılaştırıldı.
Bulgular: Hasta ve kontrol grubu cinsiyet (p=0,522) ve yaş (p=0,051) açısından benzerdi. Graves hastalarının NLO'su kontrol grubuna göre anlamlı derecede düşüktü (p=0,004). Gruplar arasında PLO (p=0,120) ve SII (p=0,577) açısından anlamlı fark yoktu. Hastaların bazal TRAb düzeyleri fT3 (r:0,283, p<0,001), fT4 (r:0,252, p<0,001) ve TSI (r:0,673, p<0,001) ile anlamlı pozitif korelasyona sahipti. TRAb ve TSI seviyeleri, inflamatuar belirteçler ve hematolojik parametreler arasında anlamlı bir ilişki yoktu.
Sonuç: Graves hastalarında kontrol grubuna kıyasla daha düşük NLO değerleri saptandı. Hasta ve kontrol grupları arasında PLO ve SII açısından anlamlı fark yoktu. Tiroid otoantikor seviyeleri ile inflamatuar belirteçler arasında anlamlı bir korelasyon yoktu.
Anahtar kelimeler: Hipertiroidizm, inflamasyon, nötrofil, lenfosit

Keywords

Hipertiroidizm inflamasyon nötrofil lenfosit

Ethical Statement

The study was approved by Batman Training and Research Hospital Ethics Committee (Decision: 356/21.06.2023). The research was conducted in accordance with Good Clinical Practice (Declaration of Helsinki of 1975). Written consent form was obtained from all participants.

Thanks

We would like to thank to the Society of Endocrinology and Metabolism of Turkey.

References

  • 1. Smith TJ, Hegedüs L. Graves' Disease. N Engl J Med. 2016;375(16):1552-65. https://doi.org/10.1056/nejmra1510030
  • 2. Ehlers M, Schott M, Allelein S. Graves' disease in clinical perspective. Front Biosci 2019;24(1):35-47. https://doi.org/10.2741/4708
  • 3. Antonelli A, Ferrari SM, Ragusa F, Elia G, Paparo SR, Ruffilli I, et al. Graves' disease: Epidemiology, genetic and environmental risk factors and viruses. Best Pract Res Clin Endocrinol Metab. 2020;34(1):101387. https://doi.org/10.1016/j.beem.2020.101387
  • 4. He M, Wang Y, Wang J, Sui J, Ding X, Chen Z, et al. The potential markers involved in newly diagnosed graves' disease and the development of active graves' orbitopathy. Cytokine. 2020;127:154998. https://doi.org/10.1016/j.cyto.2020.154998
  • 5. Wang Y, Chen Z, Wang T, Guo H, Liu Y, Dang N, et al. A novel CD4+ CTL subtype characterized by chemotaxis and inflammation is involved in the pathogenesis of graves' orbitopathy. Cell Mol Immunol. 2021;18(3):735-5. https://doi.org/10.1038/s41423-020-00615-2
  • 6. Celik T. Neutrophil-to-lymphocyte ratio in thyroid ophthalmopathy. Bratisl Lek Listy. 2017;118(8):495-98. https://doi.org/10.4149/bll_2017_095
  • 7. Yuksel N, Saritas O, Yuksel E. Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe graves' ophthalmopathy. Int Ophthalmol. 2023;43:3355–62. https://doi.org/10.1007/s10792-023-02742-x
  • 8. Dagdeviren M, Akkan T, Yapar D, Karakaya S, Dagdeviren T, Ertugrul D, et al. Can neutrophil/lymphocyte ratio be used as an indicator of inflammation in patients with hyperthyroidism? J Med Biochem. 2020;39(1):7-12. https://doi.org/10.2478/jomb-2019-0004
  • 9. Szydełko J, Litwińczuk M, Szydełko M, Matyjaszek-Matuszek B. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in relation to clinical parameters and smoking status in patients with graves' orbitopathy-novel insight into old tests. J Clin Med. 2020;9(10):3111. https://doi.org/10.3390/jcm9103111
  • 10. Turan E. Evaluation of neutrophil-to-lymphocyte ratio and hematologic parameters in patients with graves' disease. Bratisl Lek Listy. 2019;120(6):476-80. https://doi.org/10.4149/bll_2019_076
  • 11. Dorgalaleh A, Mahmoodi M, Varmaghani B, Kiani Node F, Saeeidi Kia O, Alizadeh Sh, et al. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran J Ped Hematol Oncol. 2013;3(2):73-7.
  • 12. Aggarwal N, Tee SA, Saqib W, Fretwell T, Summerfield GP, Razvi S. Treatment of hyperthyroidism with antithyroid drugs corrects mild neutropenia in graves' disease. Clin Endocrinol (Oxf). 2016;85(6):949-53. https://doi.org/10.1111/cen.13133
  • 13. Scappaticcio L, Maiorino MI, Maio A, Esposito K, Bellastella G. Neutropenia in patients with hyperthyroidism: Systematic review and meta-analysis. Clin Endocrinol (Oxf). 2021;94(3):473-83. https://doi.org/10.1111/cen.14313
  • 14. Shekhda KM. The association of hyperthyroidism and immune thrombocytopenia: Are we still missing something? Ci Ji Yi Xue Za Zhi. 2018;30(3):188-90. https://doi.org/10.4103/tcmj.tcmj_139_17
  • 15. Ren X, Meng Z, Liu M, Zhu M, He Q, Zhang Q, et al. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine (Baltimore). 2016;95(40):e4573. https://doi.org/10.1097/md.0000000000004573
  • 16. Marazuela M. Lymphocyte traffic and homing in autoimmune thyroid disorders. Eur J Endocrinol. 1999;140(4):287-90. https://doi.org/10.1530/eje.0.1400287
  • 17. Tuli G, Munarin J, Mazzucco B, Matarazzo P, de Sanctis L. Lymphocyte population in peripheral blood in children and adolescents with graves disease. Potential predictive tool for severity of the disease. Endocrine. 2022;77(2):319-4. https://doi.org/10.1007/s12020-022-03088-7
  • 18. Cheng CW, Fang WF, Tang KT, Lin JD. Serum interferon levels associated with the disease activity in women with overt graves' disease. Cytokine. 2021;138:155353. https://doi.org/10.1016/j.cyto.2020.155353
  • 19. Kim M, Kim BH, Jang MH, Kim JM, Kim EH, Jeon YK, et al. High neutrophil-to-lymphocyte ratio is associated with relapse in graves' disease after antithyroid drug therapy. Endocrine. 2020;67(2):406-11. https://doi.org/10.1007/s12020-019-02137-y
  • 20. Zhang X, Han C, Wang H, Sun X, Dou X, He X, et al. The correlation of the neutrophil-lymphocyte ratio to clinical and imaging parameters in patients with thyroid eye disease. Endocr Connect. 2022;11(11):e220260. https://doi.org/10.1530/ec-22-0260
  • 21. Keskin C, Dilekci EN, Uc ZA, Cengiz D, Duran C. Can the systemic immune-inflammation index be used as a novel diagnostic tool in the diagnosis of subacute thyroiditis? Biomark Med. 2022;16(10):791-97. https://doi.org/10.2217/bmm-2022-0095
  • 22. Ciftel S, Tuzun Z. Could the systemic immune inflammation index predict diagnosis, recovery time, hypothyroidism, and recurrence rates in subacute thyroiditis? Int J Gen Med. 2023;16:1375-82. https://doi.org/10.2147/ijgm.s406724
  • 23. Alay M, Sonmez GM, Yildiz S. Evaluation of neutrophil-to-lymphocyte ratio and mean platelet volume in patients with hyperthyroidism. Eastern J Med. 2020;25(3):388-92. https://dx.doi.org/10.5505/ejm.2020.79037
  • 24. Taskaldiran I, Omma T, Onder CE, Firat SN, Koc G, Kilic MK, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-tolymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci. 2019;49(6):1687-92. https://doi.org/10.3906/sag-1901-116
There are 24 citations in total.

Details

Primary Language English
Subjects Endocrinology
Journal Section Original Research
Authors

Hasan Atlı 0000-0003-2146-2290

Ramazan Dayanan 0000-0003-0475-6203

Publication Date October 12, 2023
Submission Date July 6, 2023
Acceptance Date September 4, 2023
Published in Issue Year 2023 Volume: 8 Issue: 5

Cite

APA Atlı, H., & Dayanan, R. (2023). Evaluation of hematologic inflammatory markers in Graves’ disease. Family Practice and Palliative Care, 8(5), 112-117. https://doi.org/10.22391/fppc.1322984
AMA Atlı H, Dayanan R. Evaluation of hematologic inflammatory markers in Graves’ disease. Fam Pract Palliat Care. October 2023;8(5):112-117. doi:10.22391/fppc.1322984
Chicago Atlı, Hasan, and Ramazan Dayanan. “Evaluation of Hematologic Inflammatory Markers in Graves’ Disease”. Family Practice and Palliative Care 8, no. 5 (October 2023): 112-17. https://doi.org/10.22391/fppc.1322984.
EndNote Atlı H, Dayanan R (October 1, 2023) Evaluation of hematologic inflammatory markers in Graves’ disease. Family Practice and Palliative Care 8 5 112–117.
IEEE H. Atlı and R. Dayanan, “Evaluation of hematologic inflammatory markers in Graves’ disease”, Fam Pract Palliat Care, vol. 8, no. 5, pp. 112–117, 2023, doi: 10.22391/fppc.1322984.
ISNAD Atlı, Hasan - Dayanan, Ramazan. “Evaluation of Hematologic Inflammatory Markers in Graves’ Disease”. Family Practice and Palliative Care 8/5 (October 2023), 112-117. https://doi.org/10.22391/fppc.1322984.
JAMA Atlı H, Dayanan R. Evaluation of hematologic inflammatory markers in Graves’ disease. Fam Pract Palliat Care. 2023;8:112–117.
MLA Atlı, Hasan and Ramazan Dayanan. “Evaluation of Hematologic Inflammatory Markers in Graves’ Disease”. Family Practice and Palliative Care, vol. 8, no. 5, 2023, pp. 112-7, doi:10.22391/fppc.1322984.
Vancouver Atlı H, Dayanan R. Evaluation of hematologic inflammatory markers in Graves’ disease. Fam Pract Palliat Care. 2023;8(5):112-7.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505