Comparison of Mean Platelet Volume, Platelet Distribution Width, Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio and Lymphocyte/Monocyte Ratio in Patients with Differentiated Thyroid Cancer According to TSH Levels

Öz

Purpose: The standard treatment in differentiated thyroid cancer (DTC) is total thyroidectomy followed by lifelong levothyroxine (LT4) replacement. However, what should be the level of exogenous LT4 and TSH is still a matter of debate. Material and Method: 162 patients with a prospective diagnosis of non-metastatic DTC and 69 healthy volunteers were included. DTC patients were divided into 3 groups according to their TSH level. If TSH is less than 0.1μIU/mL, between 0.11-0.49 μIU/mL, 0.5-2μIU/mL, the groups were named as suppressed thyrotropin, moderately suppressed thyrotropin and low-normal thyrotropin group, respectively. Results: No statistical difference was observed between MPV, PDW, NLR, PLR, LMR when the DTC group and the healthy control group were compared. When the patients were divided into 3 groups according to their TSH levels, only PDW levels were found to be higher in the moderately suppressed group compared to the other groups (p <0.001). Besides, a positive correlation was found between TSH levels and LMR (r=0.154, p=0.020), and fT4 levels were negatively correlated with LMR (r=-0.146, p=0.028). In the linear regression analysis, it was found that 1 unit increase in duration of LT4 use increases MPV by 0.070 units (p=0.031), and 1 unit increase in TSH increases LMR 0.517 units (p=0.041). An increase of T3 by 1 unit reduces the NLR by 0.282 units (p=0.032). Conclusion: In DTC patients, excessive LT4 dose for target TSH level may increase the risk of inflammatory and cardiovascular disease as well as low dose. Each patient should be treated individually and when making LT4 dose adjustment their age, comorbid diseases, and disease stage should be taken into account. Long-term studies are needed to determine what the target TSH optimum value should be.

Anahtar Kelimeler

• Mean Platelet Volüme;
• Differantieted Thyroid Cancer ;
• Platelet Distrubition Width

Differansiye Tiroid Kanserli Hastalarda TSH Düzeylerine Göre Ortalama Platelet Volümü, Platelet Dağılım Genişliği, Nötrofil/ Lenfosit Oranı, Platelet/Lenfosit Oranı ve Lenfosit/Monosit Oranının Karşılaştırılması

Öz

Amaç:Diferansiye tiroid kanseri (DTK) standart tedavi total tiroidektomi ve sonrasında ömür boyu levotiroksin (LT4) replasmanı yapılmasıdır. Fakat ekzojen LT4 ile TSH düzeyinin ne olması gerektiği halen tartışma konusudur. Gereç ve Yöntemler: Prospekif non metastatik DTK tanısı olan 162 hasta ile 69 sağlıklı gönüllü alındı. DTK hastaları TSH seviyesine göre 3 gruba ayrıldı. TSH: 0,1μIU/mLden küçük ise suprese tirotropin TSH:0,11-0,49 μIU/mLarasında ise ılımlı suprese tirotropin TSH :0,5- 2μIU/mL arasında düşük -normal tirotropin grubu olarak adlandırıldı. Bulgular:DTK ve sağlıklı kontrol grubu arasında MPV, PDW, NLR,PLR, LMR arasında istatistiksel fark saptanmadı.HastalarTSH düzeyine göre 3 gruba ayrılınca sadece PDW düzeyleri diğer 3 gruba göre ılımlı suprese grupta yüksek saptandı. (p <0,001).Ayrıca TSH düzeyleri ile LMR arasında pozitif yönlü (r=0,154 p=0,020), sT4 düzeyleri LMR ile negatif yönde düşük korelasyon saptanmıştır. (r=-0,146 p=0,028 ) Lineer regresyon analizinde LT4 kullanma süresinin 1 birim artması MPW’ı ortalama 0,070 birim (p=0,031), TSH’ın 1 birim artması LMR’yi ortalama 0,517 birim arttırmaktadır (p=0,041). T3’ün 1 birim artması NLR’ı ortalama 0,282 birim azaltmaktadır (p=0,032). Sonuç: DTK hastalarında hedef TSH düzeyi için verilen LT4 dozunun fazla olması kadar, az olması da inflamatuar, kardiovasküler hastalık riski artırmaktadır. Her hasta bireysel ele alınıp, yaş, ek hastalıkları, hastalık evresi gibi durumları göz önüne alınarak LT4 doz ayarlaması yapılmalıdır. Hedef TSH optimum değerinin ne olması gerektiği için uzun süreli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Differansiye Tiroid Kanser ;
• Ortalama Platelet Volümü
• Ortalama Platelet Dağılımı

Kaynakça

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