Graves Hastalığında Başlangıç ve Tedavinin 6. Ayında Hemogramdaki İnflamatuar Parametreler ile Tiroid Stimulan İmmunglobulin (TSI) Düzeyi Arasındaki İlişki

Abstract

Öz Giriş ve Amaç: Tirotoksikozun ayırıcı tanısında, hastalık nüksü ve aktivitesini göstermede TSI kullanılmaktadır. Ancak ulaşılabilirlik ve maliyet TSI kullanımını sınırlandırmaktadır. Çalışmamızda, Graves hastalığı (GH) tanı ve takibinde TSI yerine kullanılabilecek ve kolay ulaşılabilen belirteç varlığı araştırılmıştır. Hastaların başlangıç ve antitiroidal tedavi sonrası 6. aydaki tam kan sayımından elde edilen nötrofil lenfosit oranı (NLO), monosit lenfosit oranının (MLO), trombosit lenfosit oranı (TLO), sistemik immün inflamasyon (SII) indeksi, pan-immün inflamasyon değeri (PIV) gibi inflamatuar belirteçler ile TSI düzeyleri arasındaki ilişkinin değerlendirmesi amaçlanmıştır. Gereç ve Yöntemler: Graves hastalığı tanılı 162 hasta retrospektif olarak incelendi. Serbest T4 düzeyine göre hastalar, hafif, orta, ağır şiddetli hastalık olarak 3’e ayrıldı. Hastaların tanı anındaki ve 6 ay antitiroid tedavi sonrasındaki tiroid fonksiyon testleri, hemogram parametreleri ve TSI değerleri karşılaştırıldı. İstatistiksel olarak anlamlı bulunan parametrelerin TSI ile korelasyonu her grup için ayrı ayrı incelendi. Bulgular: Tedavi sonrası başlangıca göre hemoglobin (p=0.009), lökosit (p=0.001), nötrofil (p=0.002), lenfosit (p=0.002), eozinofil (p=0.033), bazofil (p=0.001) ve TSH (p=0.001) anlamlı artış varken; monosit (p=0.003), trombosit (p=0.010), TLO (p=0.001), MLO (p=0.001), sT3 (p=0.001), sT4 (p=0.001) düzeylerinde anlamlı azalma izlendi. İstatistiksel olarak anlamlı bulunan bu parametrelerin TSI ile korelasyonu incelendi. Tüm hastalarda başlangıç ve tedavi sonrası 6. ay değerleri incelendiğinde; TSI ile monosit ve MLO arasında pozitif yönde çok zayıf korelasyon ve sT3 ile pozitif yönde zayıf korelasyon tespit edildi. Ağır şiddetli hastalık grubunda TSI ile RDW ve sT3 arasında pozitif yönde zayıf korelasyon saptandı. Sonuç: Graves hastalığı takibinde TSI’ya alternatif olarak kullanılabilecek güvenilir bir belirteç saptanmamış olsa da monosit, MLO ve ağır şiddetli hastalarda RDW’nin hastalık takibinde aktivasyonu göstermede fikir verebileceği düşünülebilir.

Keywords

• Graves hastalığı
• İnflamatuar parametreler
• Tiroid Stimülan İmmünglobulin

The Relationship Between Inflammatory Parameters in Hemogram and Thyroid Stimulating Immunoglobulin (TSI) Levels at the Beginning and the 6th Month of Treatment in Graves' Disease

Abstract

Abstract Objective: Thyroid stimulating immunoglobulin (TSI) is used in the differential diagnosis of thyrotoxicosis and disease recurrence and activity. However, the accessibility and the cost can limit the use of TSI. In our study, we investigated the existence of easily accessible markers that can be used instead of TSI in the diagnosis and follow-up of Graves' disease (GD). The aim was to evaluate the relationship between TSI levels and inflammatory markers such as neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (TLR), systemic immune inflammation (SII) index, pan-immune inflammation value (PIV) obtained from the complete blood count of the patients at the beginning and 6 months after anti-thyroid treatment. Materials and Methods: 162 patients diagnosed with Graves' disease were retrospectively investigated. According to the free T4 level, the patients were divided into 3 groups as mild, moderate, and severe disease. Thyroid function tests, hemogram parameters, and TSI values of the patients at the time of diagnosis and after 6 months of anti-thyroid treatment were compared. The correlation of the statistically significant parameters with TSI was studied separately for each group. Results: While there was a significant increase in hemoglobin (p=0.009), leukocyte (p=0.001), neutrophil (p=0.002), lymphocyte (p=0.002), eosinophil (p=0.033), basophil (p=0.001) and TSH (p=0.001) levels after treatment compared to the baseline, there was a significant decrease in monocyte (p=0.003), platelet (p=0.010), TLR (p=0.001), MLR (p=0.001), freeT3 (p=0.001), freeT4 (p=0.001) levels. The correlation of these statistically significant parameters with TSI was observed. When the baseline and 6th month post-treatment values were investigated in all patients; a weak positive correlation was detected between TSI and monocytes and MLR, and a weak positive correlation was detected with freeT3. A weak positive correlation was detected between TSI and RDW and freeT3 in the severe disease group. Conclusion: Although a reliable marker that can be used as an alternative to TSI in the follow-up of Graves' disease has not been available, monocyte level, MLR and RDW in patients with severe Graves’ disease may predict an activation in the follow-up of the disease.

Keywords

• Graves
• Inflammatory parameters
• Thyroid Stimulating Immunoglobulin

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