Hemogram parameters in the patients with subacute thyroiditis

The Role of Blood Cell-Derived Parameters in the Differential Diagnosis of Subacute Thyroiditis and Graves' Disease and Long-Term Outcomes in Subacute Thyroiditis

PURPOSE

To assess the utility of blood cell-derived parameters in differentiating subacute thyroiditis (SAT) from Graves' disease (GD) and their association with recurrence and the development of permanent hypothyroidism in the patients with SAT.

METHODS

The study involved 414 patients with SAT, 415 patients with GD, and 92 healthy controls. Pre-treatment hematological parameters were retrospectively compared, especially in cases where differentiation is challenging, including painless SAT, acute phase reactants negative SAT, and TSI, TRAB (Thyroid Stimulating Immunoglobulin, TSH-receptor-antibodies) negative GD. Factors influencing recurrence and permanent hypothyroidism were also analyzed in SAT group.

RESULTS

When compared with the GD group, ratios of neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), systemic inflammatory response index (SIRI), systemic immune inflammatory index (SII) and pan immune inflammation value (PIV) were significantly higher, while large unstained cell percentage (LUC%) and the ratios of eosinophil/monocyte (EMR), eosinophil/lymphocyte (ELR), eosinophil/neutrophil (ENR), eosinophil/platelet (EPR), mean platelet volume/neutrophil (MPV/NEU), MPV/monocyte and MPV/platelets were significantly lower in the SAT group. SII demonstrated the highest diagnostic value, with an optimal cutoff of 652,784. No significant association was observed between these parameters and recurrence or permanent hypothyroidism.

CONCLUSION

Differentiation between SAT and GD can be reliably achieved using blood cell-derived parameters, and that these markers are also applicable in groups where differentiation is challenging. To the best of our knowledge, this is the first study to investigate the LUC%, ELR, ENR, EPR, MPV/NEU, and MPV/monocyte ratios and revealed that they are significantly different between these two diseases.

The prognostic value of mean platelet volume levels in germinal matrix hemorrhage- intraventricular hemorrhage in preterm infants

Objective

Germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) is currently the most significant cause of brain damage and mortality seen in preterm infants. The aim of this study was to evaluate the predictive value of mean platelet volume (MPV) in diagnosing GMH-IVH and mortality.

Method

A retrospective-cohort study of preterm infants with a gestational age <32 weeks or with birthweight <1500gr who were admitted to the Neonatal Intensive Care Unit was conducted between January 2020 and January 2022. These infants were then classified into two groups according to the presence of GMH-IVH.

Results

Overall, 136 preterm infants were enrolled. The MPV levels were significantly higher in the GMH-IVH group (p <0.001). A MPV cutoff of >9.95 was determined to be predictive for GMH-IVH with sensitivity of 62% and specificity of 80% (p < 0.001). Mortality was significantly higher in the GMH-IVH group (p<0.001). A MPV cutoff of >10.55 fL was determined to predict mortality with 77% sensitivity and 70% specificity (p < 0.001).

Conclusions

The MPV value is significantly higher in infants with GMH-IVH and therefore can be used in the prediction of GMH-IVH and mortality in preterm infants.

The role of severity and duration of inflammation and hematological parameters on the outcome of subacute thyroiditis

Background: The role of severity and duration of inflammatory findings on the development of persistent hypothyroidism and anemia has not been clarified in subacute thyroiditis (SAT). Methods: Demographic data and laboratory parameters of patients with SAT were analyzed retrospectively. Results: Permanent hypothyroidism was observed in 28.1% of patients. Baseline elevated erythrocyte sedimentation rate as defined >74.5 mm/h was found to be associated with permanent hypothyroidism, but the duration of inflammation was not different between the recovered and hypothyroid patients. Baseline hemoglobin values improved without specific therapy in 3.5 months. Conclusion: The initial severity but not the duration of inflammation increases the risk for the development of permanent thyroid dysfunction, and anemia improves with the resolution of inflammation.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio in the Patients with Euthyroid Hashimoto's Thyroiditis

Objective

This study aimed to compare the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values in patients with euthyroid Hashimoto's thyroiditis (HT) with healthy control subjects.

Methods

This was a single-center, retrospective, cross-sectional study conducted on obese patients aged 18 years and over. The medical records of patients who presented with complaints of being overweight at the obesity clinic between April 2017 and May 2019 were examined. Patients and healthy individuals were included in the study consecutively until the sample sizes reached saturation. Patients with diabetes, cardiovascular disease, chronic inflammatory disease, and malignancy were excluded from the study. The patients' anthropometric measurements, smoking status, blood examination, and thyroid ultrasounds were evaluated. The difference in means between the groups was calculated using the Mann-Whitney U test.

Results

The study included 179 participants, consisting of 93 patients and 86 healthy controls. The mean age was 46.6±14.1 years, with most females (91.6%). Although the NLR and PLR values in patients were higher than those in the control group, the difference did not reach statistical significance (p=0.427 and p=0.089, respectively). Furthermore, no significant difference was observed in NLR (p=0.191) and PLR (p=0.668) values between levothyroxine-treated and untreated patients. Correlation analysis revealed weak positive associations between C-reactive protein and thyroid peroxidase antibodies (p<0.05), neutrophils (p<0.01), platelets (p<0.01), and NLR (p<0.05).

Conclusions

The findings of this study suggest that NLR and PLR may not serve as effective indicators of systemic inflammation in patients with euthyroid HT, nor do they adequately assess the impact of levothyroxine usage on systemic inflammation.

The Old and the New in Subacute Thyroiditis: An Integrative Review

Subacute thyroiditis (SAT) is the most common cause of neck pain and thyrotoxicosis. Although this disease was recognized already by the end of the 18th century, new concepts regarding pathogenesis have emerged in recent years. Moreover, in the last two years, literature on SAT has increased significantly due to articles describing the possible connection with coronavirus disease 2019 (COVID-19). This integrative review depicts old and new concepts of this disease, proposing a detailed overview of pathogenesis, a practical approach to diagnosis and treatment, and a thorough description of the latest discoveries regarding the association of SAT with COVID-19.

The diagnostic value of blood cell-derived indexes in subacute thyroiditis patients with thyrotoxicosis: a retrospective study

Background

Both subacute thyroiditis (SAT) and Graves’ disease (GD) can lead to thyrotoxicosis, but the methods to distinguish these two diseases are relatively complex. Therefore, it is necessary to find biomarkers which can quickly and efficiently identify the two kinds of thyrotoxicosis. Blood cell-derived indexes are widely used to evaluate systemic inflammation. We aimed to evaluate the diagnostic value of blood cell-derived indexes in SAT patients with thyrotoxicosis.

Methods

Totally 139 SAT patients with thyrotoxicosis, 146 GD patients, and 100 euthyroid individuals were enrolled in the study. Complete blood cell (CBC) count, thyroid function, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), systemic inflammation response index (SIRI), aggregate inflammation systemic index (AISI), and mean platelet volume to platelet ratio (MPR) were evaluated in all subjects. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the capacity of blood cell-derived indexes in differentiating SAT patients with thyrotoxicosis from GD patients. We also evaluated the association between blood cell-derived indexes and other laboratory indicators and clinical outcomes in SAT patients.

Results

NLR, PLR, MLR, SII, SIRI, and AISI were significantly higher in the SAT group. MPR was significantly lower in the SAT group. A formula including NLR, PLR, MLR, SII, SIRI, AISI and MPR was developed. The combination formula with an optimal cutoff of 0.426 showed the better diagnostic value [area under the curve (AUC) =0.921; 95% confidence interval (CI): 0.891–0.950; P<0.001; sensitivity, 87.1%; specificity, 83.6%]. However, thyroid function, erythrocyte sedimentation rate (ESR), thyroid peroxidase antibodies (TPOAb), and blood cell-derived indexes, were not found to be significantly associated with hypothyroidism and recurrence.

Conclusions

We developed a formula combining 7 blood cell-derived indexes. The combination formula could be a novel biomarker to distinguish SAT patients with thyrotoxicosis from GD patients. However, we did not find significant association between the blood cell-derived indexes and clinical outcomes in SAT patients.

Early Thyroid Volume Reduction in Subacute Thyroiditis Can be a Potential Indicator for Hypothyroidism

BACKGROUND

Thyroid volume has been reported to decrease significantly after episodes of subacute thyroiditis (SAT); however, the relationship between thyroid volume and hypothyroidism remains unclear. This study assessed the association between thyroid volume changes and the hypothyroid phase in patients with SAT, a condition that can progress to persistent hypothyroidism.

METHODS

This retrospective study evaluated 37 patients diagnosed with SAT at the Department of Endocrinology and Metabolism of Chonnam National University Hwasun Hospital (CNUHH) between 2016 and 2021. Since we could not determine the clinical characteristics of patients with SAT before their episodes, 120 healthy individuals who underwent thyroid ultrasonography during regular check-ups from 2019 to 2021 at CNUHH were selected for comparison. Subgroup analyses were performed on patients with SAT with and without the hypothyroid phase during their clinical course.

RESULTS

Thyroid volume was significantly greater in SAT patients at the first visit than in controls (p<0.05), and it decreased constantly throughout the follow-up period. Subgroup analysis showed that the initial thyroid volumes were similar in patients with SAT with and without the hypothyroid phase. However, SAT patients with the hypothyroid phase had significantly smaller thyroid volumes at the 1 month (p=0.025) and 3 month (p=0.006) follow-up visits. The reduction rate of the thyroid volume was significantly different within the first month (p=0.009).

CONCLUSION

A greater reduction in thyroid volume in SAT patients within 1 month of episode had a higher chance of developing a subsequent hypothyroid phase, which can lead to persistent hypothyroidism. Serial thyroid ultrasonography in patients with SAT, especially within the first month, may help in predicting the disease course of SAT.

New aspects in the pathogenesis and management of subacute thyroiditis

Subacute thyroiditis (SAT) is a thyroid inflammatory disease, whose pathogenesis and determinants of the clinical course were unclear for many decades. The last few years have brought many clinically significant new data on the epidemiology, pathogenesis and management of SAT. Several human leukocyte antigen (HLA) alleles were demonstrated not only to increase the risk of SAT, but also to correlate with SAT clinical course and determine the risk of recurrence. The world-wide epidemic of the coronavirus disease 19 (COVID-19) has provided new observations that the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can be a potent SAT-triggering factor, and that the clinical course of SAT in patients affected by COVID-19 is different from a typical one. Additionally, many new trends in the clinical course are emerging. In the last years, painless course of SAT is more and more often described, constituting a special challenge in patients hospitalized due to COVID-19. Despite an excellent availability of diagnostic methods, several difficulties in SAT differential diagnosis can be currently encountered and the proper diagnosis and treatment is frequently delayed. False positive diagnoses of SAT in patients with malignancies of poor prognosis constitute a life-threatening problem. Taking into account all the new aspects of SAT pathogenesis and of its clinical course, the new - modified - SAT diagnosis criteria have been proposed.

Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis

Objectives:

This study was conducted to evaluate the diagnostic value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in vaginitis patients.

Methods:

This cross-sectional retrospective study was performed in Afyon Dinar State Hospital between July 2016 to August 2017. A total of 64 bacterial vaginosis (BV) patients, 66 vulvovaginal candidiasis (VVC) patients and 65 age-matched control subjects were enrolled. NLR, PLR, mean platelet volume (MPV), red cell distribution width (RDW) and other conventional inflammatory marker values were recorded for all patients before and after treatment.

Results:

In the BV group, NLR values were found to be elevated compared to VVC and healthy controls [2.9 (1.2-14.7), 2.1 (1.1-11.7) and 2.1 (0.8-7.0), respectively] (p=0.008). Although not found to be statistically significant, the median NLR levels of BV patients decreased from 2.9 (1.2-14.7) to 2.4 (1.2-7.0) after treatment. PLR levels did not show a statistically significant difference between the three groups (p=0.970). The cut-off value of the NLR for BV was 2.19, with 67.2% sensitivity and 63.8% specificity.

Conclusions:

The present study demonstrated that NLR levels are elevated in bacterial vaginosis and NLR levels can be used as a reflection of systemic inflammatory response in vaginosis patients.