Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism

Impact of parathyroidectomy on inflammatory and cardiovascular risk parameters in primary hyperparathyroidism: a retrospective analysis

BACKGROUND

Parathyroidectomy has been shown to reduce cardiovascular risk factors in some studies, although findings on these parameters remain inconsistent.

OBJECTIVES

This study aimed to evaluate inflammatory and cardiovascular risk markers in patients with Primary Hyperparathyroidism (PHPT) before and one month after successful parathyroidectomy (PTX).

METHODS

We retrospectively analyzed PHPT patients who visited the outpatient clinic between 2015 and 2020. Patient demographics, hemogram data, calcium, parathormone (PTH), vitamin D, high-density lipoprotein (HDL), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL ratio (MHR) were recorded and compared pre- and postoperatively.

RESULTS

The analysis revealed significant postoperative increases in platelet, MPV, HDL, PLR, and vitamin D levels (p = 0.001, p = 0.001, p = 0.001, p = 0.024, p = 0.001, respectively). Conversely, PTH, calcium, NLR, and MHR levels significantly decreased (p = 0.001, p = 0.001, p = 0.011, p = 0.019, respective-ly). Correlation analysis demonstrated a negative association between postoperative PTH and vitamin D (p = 0.010, r = -0.292**) and a positive association between postoperative PTH and both calcium (p = 0.008, r = 0.309**) and NLR (p = 0.046, r = 0.227**). Multivariable regression analysis demonstrated that postoperative PTH levels were significantly associated with calcium (B = 39.82, Beta = 0.321, p = 0.0469), NLR (B = 110.02, Beta = 0.428, p = 0.0384), baseline comorbidity scores (B = -30.54, Beta = -0.287, p = 0.0361), and preoperative inflammation levels (B = 25.69, Beta = 0.311, p = 0.0386).

CONCLUSION

Our findings highlight a potential link between PHPT and inflammatory-cardiovascular risk, with parathyroidectomy exerting a beneficial effect within the first month post-surgery. The study also suggests that these risk factors may be modifiable with timely surgical intervention.

CLINICAL TRIAL NUMBER

Not applicable.

Can we diagnose noninvasive follicular thyroid neoplasm with papillary-like nuclear features before surgery?

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) can be differentiated from invasive encapsulated follicular variant of papillary thyroid carcinoma (eFV-PTC) by the presence of a tumor capsule or blood vessel invasion in histological examination. The objective of this study was to investigate whether it is possible to distinguish between NIFTP and invasive eFV-PTC before surgery. Patients diagnosed with NIFTP and invasive eFV-PTC from 2017 to 2023 were analyzed for biochemical, ultrasonographic, and cytological features. No differences were found in thyroid function tests, thyroid autoantibody levels, tumor size, or ultrasonographic characteristics. However, patients with invasive eFV-PTC had higher preoperative neutrophil-to-lymphocyte ratio (NLR) values and a higher Bethesda cytology category compared to those with NIFTP. In the multivariable analysis, NLR was the only significant predictor of invasive eFV-PTC. Nevertheless, there was no reliable NLR cutoff for distinguishing between the two entities. Overall, this study substantiates considerable overlap in demographic and clinical data between NIFTP and invasive eFV-PTC. Although the higher NLR observed in thyroid cancer does not provide strong discrimination, it suggests that the invasive nature of tumor cells might elicit a more profound systemic inflammatory or immune response.

Effect of parathyroidectomy on serum inflammatory and metabolic dysfunction markers in patients with primary hyperparathyroidism

Objective

This study analyzed systemic inflammatory changes reflected by hematologic and biochemical indices in patients with hyperparathyroidism (PHPT) after parathyroidectomy.

Materials and methods

Retrospective study of 70 patients who underwent curative parathyroidectomy for PHPT treatment. Data on clinical presentation, biochemical assays, imaging studies, and postoperative outcomes were collected. Systemic inflammation was quantified using different indices, including the triglyceride-glucose (TyG) index, Fibrosis-4 (FIB-4) score, systemic immune-inflammation index (SII), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW).

Results

Significant pre-surgical to post-surgical decreases were observed in serum levels of mean normalized calcium (11 ± 0.65 mg/dL and 9.1 ± 0.42 mg/dL, respectively, p = 0.001) and parathyroid hormone (PTH) (235.5 ± 132.9 and 78.1 ± 60.5 ng/L, respectively, p = 0.001). The inflammatory indices changed substantially, with decreases in SII (from 564.8 ± 257.5 to 516.6 ± 201.1, p = 0.001) and PLR (from 143.0 ± 46.2 to 133.6 ± 38.6, p = 0.001). Additionally, PDW decreased from 52.8 ± 8.2% to 47.5 ± 9.3% (p = 0.001) and MHR increased from 7.19 ± 3.06 to 7.81 ± 3.13 (p = 0.001). No significant changes occurred in other inflammatory markers, including the TyG index (p = 0.431) and FIB-4 score (p = 0.401). Logistic regression analysis identified PDW (odds ratio [OR] 0.920, 95% confidence interval [CI] 0.879-0.963, p = 0.001) and PLR (OR 0.991, 95% CI 0.983-1, p = 0.042) as significant predictors of inflammation.

Conclusions

Successful parathyroidectomy in patients with PHPT reduces systemic inflammation, as evidenced by decreased PDW and PLR. Our results indicate the importance of integrating PDW and PLR in the postoperative assessment of PHPT for monitoring inflammatory activity.

The unexpected effect of parathyroid adenoma on inflammation

Primary hyperparathyroidism (PHPT) is an endocrinological disease that affects systemic inflammation. This study is aimed to investigate the preoperative and postoperative effect of PHPT on systemic inflammation. A total of 203 patients who were successfully operated for PHPT and 98 healthy controls were included in the study. The blood tests of the patients in the last month preoperatively and in the postoperative 6th month were compared. In addition, preoperative and postoperative tests were compared with the healthy control group. When the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) values of the patients who were operated for parathyroid adenoma were compared with the control group (p values were < 0.05, 0.01, 0.19, < 0.05), the NLR, PLR, and SII values were significantly lower in the patient group with parathyroid adenoma than in the control group. When the preoperative and postoperative 6th month NLR, PLR, LMR, and SII values of the patients were compared (p values: 0.026, 0.56, 0.023, 0.016, respectively), there was a significant increase in NLR and SII values after excision, while a significant decrease was observed in the LMR value. When the postoperative 6th month NLR, PLR, LMR, SII values were compared with the healthy control group (p values: 0.22, 0.29, 0.19, 0.29, respectively), no significant difference was observed between all values. We found that the immune system was suppressed in PHPT and this returned to normal levels after a successful surgery.

Assessing causal associations of hyperparathyroidism with blood counts and biochemical indicators: a Mendelian randomization study

Background

The existing literature on the relationship of hyperparathyroidism with both blood counts and biochemical indicators primarily comprises observational studies, which have produced inconsistent findings. This study aimed to evaluate the causal relationship between hyperparathyroidism and blood counts and biochemical indicators.

Methods

Mendelian randomization (MR) analyses were conducted to investigate the associations between hyperparathyroidism and the identified 55 blood counts and biochemical indicators. The genome-wide association study (GWAS) for hyperparathyroidism data was obtained from FinnGen, while the GWASs for the blood counts and biochemical indicators were sourced from the UK Biobank (UKBB).

Results

The MR analysis using the inverse-variance weighted (IVW) method revealed potential causality between genetically predicted hyperparathyroidism and seven out of 55 blood counts and biochemical indicators. These markers include "Platelet count" (Beta = -0.041; 95% CI: -0.066, -0.016; p = 0.001), "Platelet distribution width (PDW)" (Beta = 0.031; 95% CI: 0.006, 0.056; p = 0.016), "Mean platelet volume (MPV)" (Beta = 0.043; 95% CI: 0.010, 0.076; p = 0.011), "Vitamin D" (Beta = -0.038; 95% CI: -0.063, -0.013; p = 0.003), "Calcium (Ca2+)" (Beta = 0.266; 95% CI: 0.022, 0.509; p = 0.033), "Phosphate" (Beta = -0.114; 95% CI: -0.214, -0.014; p = 0.025), and "Alkaline phosphatase (ALP)" (Beta = 0.030; 95% CI: 0.010, 0.049; p = 0.003).

Conclusion

The findings of our study revealed a suggestive causal relationship between hyperparathyroidism and blood cell count as well as biochemical markers. This presents a novel perspective for further investigating the etiology and pathological mechanisms underlying hyperparathyroidism.

Preoperative inflammatory markers for predicting parathyroid carcinoma

OBJECTIVE

Parathyroid carcinoma is a rare tumor among parathyroid tumors. Aspiration cytology and needle biopsy are generally not recommended for diagnostic purposes because they cause dissemination. Therefore, it is commonly diagnosed by postoperative histopathological examination. In this study, we investigated whether preoperative inflammatory markers can be used as predictors of cancer in patients with primary hyperparathyroidism.

DESIGN

This was a retrospective study.

METHODS

Thirty-six cases of parathyroid carcinoma and 50 cases of parathyroid adenoma (PA) operated with the diagnosis of primary hyperparathyroidism and confirmed histopathologically at Ito Hospital were included in this study. Preoperative clinical characteristics and inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR)) were compared and their values in preoperative prediction were evaluated and analyzed.

RESULTS

Preoperative intact-parathyroid hormone (P = 0.0003), serum calcium (P = 0.0048), and tumor diameter (P = 0.0002) were significantly higher in parathyroid carcinoma than in PA. LMR showed a significant decrease in parathyroid carcinoma (P = 0.0062). In multivariate analysis, LMR and tumor length diameter were independent predictors. In the receiver operating characteristics analysis, the cut-off values for LMR and tumor length diameter were 4.85 and 28.0 mm, respectively, for parathyroid cancer prediction. When the two extracted factors were stratified by the number of factors held, the predictive ability improved as the number of factors increased.

CONCLUSION

In the preoperative evaluation, a combination of tumor length diameter of more than 28 mm and LMR of less than 4.85 was considered to have a high probability of cancer.

Double water-clear cell parathyroid adenoma: a case report and literature review

Water-clear cell parathyroid adenoma is an uncommon cause of primary hyperparathyroidism. Herein, we report an interesting case of a 56-year-old man who presented with weight loss, bone pain, fatigue, and a palpable right neck mass. Laboratory tests indicated hypercalcemia, elevated parathyroid hormone (PTH) levels, and normal thyroid function. Further examinations detected osteoporosis and kidney stones. The ultrasound of neck revealed bilateral extrathyroidal tumors, which were sestamibi-avid. The patient underwent resection of the large right inferior and left inferior parathyroid tumors. Histopathology revealed a double water-clear cell parathyroid adenoma. His serum calcium and PTH levels normalized after surgery. The literature review identified 37 cases of water-clear cell parathyroid adenoma between 1985 and 2021. The median age at diagnosis was 56 years. Classic complications were common, including nephrolithiasis in nine and skeletal presentations in 10 patients. Before surgery, the median calcium and PTH levels were 12.0 mg/dL and 290 pg/mL, respectively. Overall, 89% were localized on ultrasonography, and 60% were positive on scintigraphy. Four patients had double adenomas. The median maximum diameter was 3.8 cm, and the median weight of the resected adenoma was 5.27 g. In summary, water-clear cell parathyroid adenoma has certain unique features. These include larger tumor size, relatively indolent biochemical profile, high prevalence of complications and nonspecific symptoms, an isoechoic appearance on ultrasonography, and reduced scintigraphic sensitivity.

Serum Inflammation-based Scores in Endocrine Tumors

CONTEXT

Serum inflammation-based scores reflect systemic inflammatory response and/or patients' nutritional status, and may predict clinical outcomes in cancer. While these are well-described and increasingly used in different cancers, their clinical usefulness in the management of patients with endocrine tumors is less known.

EVIDENCE ACQUISITION

A comprehensive PubMed search was performed using the terms "endocrine tumor," "inflammation," "serum inflammation-based score," "inflammatory-based score," "inflammatory response-related scoring," "systemic inflammatory response markers," "neutrophil-to-lymphocyte ratio," "neutrophil-to-platelet ratio," "lymphocyte-to-monocyte ratio," "Glasgow prognostic score," "neutrophil-platelet score," "Systemic Immune-Inflammation Index," and "Prognostic Nutrition Index" in clinical studies.

EVIDENCE SYNTHESIS

The neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio are the ones most extensively investigated in patients with endocrine tumors. Other scores have also been considered in some studies. Several studies focused in finding whether serum inflammatory biomarkers may stratify the endocrine tumor patients' risk and detect those at risk for developing more aggressive and/or refractory disease, particularly after endocrine surgery.

CONCLUSIONS

In this review, we summarize the current knowledge on the different serum inflammation-based scores and their usefulness in predicting the phenotype, clinical aggressiveness, and disease outcomes and prognosis in patients with endocrine tumors. The value of such serum inflammation-based scores in the management of patients with endocrine tumors has been emerging over the last decade. However, further research is necessary to establish useful markers and their cut-offs for routine clinical practice for individual diseases.

Does Parathyroidectomy Affect the Neutrophil/Lymphocyte Ratio, a Systemic Inflammatory Marker?

Introduction

Primary hyperparathyroidism (PHPT) is an endocrinological disorder associated with increased systemic inflammation. This study aimed to examine the changes in the neutrophil/lymphocyte ratio (NLR), serum parathormone, serum corrected calcium, serum phosphate, and white blood cell (WBC) count ​​in patients with PHPT before and after parathyroidectomy.

Methods

A total of 37 patients who underwent successful parathyroidectomy for PHPT were included in the study. NLR, serum parathormone, serum corrected calcium, serum phosphate, and WBC count ​​were compared before parathyroidectomy and at the sixth postoperative month.

Results

The difference in the NLR, serum parathormone, serum corrected calcium, and serum phosphate values ​​before and after parathyroidectomy was statistically significant (p=0.019, p<0.001, p<0.001, and p<0.001, respectively), but there was no significant difference in the WBC count ​​(p=0.314). The correlation analysis performed before parathyroidectomy revealed a significant positive correlation between NLR and serum parathormone (r=0.519, p=0.001), serum corrected calcium (r=0.390, p=0.017) and WBC count (r=0.531, p=0.001), and a significant negative correlation between NLR and serum phosphate (r=-0.331).

Conclusion

In patients with PHPT, successful parathyroidectomy results in a decrease in NLR. Increased systemic inflammation in patients with PHPT can be reduced following parathyroidectomy.

Emodin improves the cardiac function in the rats with chronic heart failure through regulation of the miR-26b-5p/PTEN pathway

Introduction

Chronic heart failure (CHF) is a leading cause of deaths induced by cardiovascular disease. This study aimed to investigate the protective effects of emodin in CHF rats and explore the related mechanisms.

Material and methods

A total of 56 Wistar rats were used to construct CHF model using the coronary artery ligation. The effects of emodin on cardiac function and inflammation were analyzed in the CHF rats. Expression of miR-26b-5p in the CHF model before and after emodin treatment was estimated by quantitative real-time polymerase chain reaction. The effects of miR-26b-5p on cardiac function and inflammation were also assessed, and its target gene was predicted and confirmed in rat cardiomyocyte H9c2.

Results

Emodin treatment could significant improve the cardiac function and inflammation evidenced by the increased increased ejection fraction (EF), fractional shortening (FS), left ventricular systolic pressure (LVSP) and maximum of the first differentiation of left ventricular pressure (+LV dP/dtmax) and decreased atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), left ventricular end diastolic pressure (LVEDP), interleukin (IL)-6, tumor necrosis factor α (TNF-α) levels. Expression of miR-26b-5p was downregulated in the CHF rats (CHF 0.442 ±0.131 vs. Sham 1.044 ±0.160), and this suppressive effect was rescued by emodin (Emodin 0.902 ±0.132 vs. CHF 0.442 ±0.131). The overexpression of miR-26b-5p in CHF rats led to improved cardiac function and inflammatory response. In addition, the emodin-induced increased EF, FS, LVSP and +LV dP/dtmax and decreased ANP, BNP, LVEDP, IL-6 and TNF-α were all abrogated by the knockdown of miR-26b-5p. The target prediction results revealed that PTEN was a target gene of miR-26b-5p in H9c2 cells.

Conclusions

All the results indicated that emodin serves a protective role in CHF via regulation of the miR-26b-5p/PTEN pathway. Emodin may be an effective therapeutic agent for CHF treatment.