Dasgupta Riddhi, Atri Avica, Jebasingh Felix, Hepzhibah Julie, Christudoss Pamela, Asha Hs, Paul Thomas V, Thomas Nihal
Department of Endocrinology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Department of Endocrinology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
Endocr Pract. 2020 Sep;26(9):939-944. doi: 10.4158/EP-2020-0086.
Graves disease (GD) and the toxic phase of subacute thyroiditis (SAT) have similar clinical and biochemical presentations, and differentiating them requires sophisticated investigations. Since thyroid hormones have been noted to affect all hematologic cell lines, we have used the platelet lymphocyte ratio (PLR)-an index usually utilized in inflammatory or malignant disorders-to compare patients with and without thyrotoxicosis and to analyze its use in distinguishing between patients with GD and SAT prior to therapy.
This was a cross-sectional study conducted in the Department of Endocrinology, Christian Medical College, Vellore, India. During the study period, 800 patients with features of thyrotoxicosis visited the outpatient clinic. Those who had thyroid radioiodine (I) uptake (RAIU) study and complete blood count (CBC) at diagnosis were included (N = 500). Based on the RAIU values, these were divided as GD (n = 354) and SAT (n = 146). Baseline characteristics, thyroid function tests, and components of the CBC and PLR were obtained. The data were compared with a group of 250 matched euthyroid controls. Analyses were performed using SPSS version 21.0 software.
PLR showed significant reductions in both GD and SAT patients when compared to euthyroid controls (P = .01), with greater reductions seen in GD than SAT (74.5 ± 19 vs. 84.4 ± 26; P = .01). Using receiver operating characteristic analysis of PLR, an optimal PLR cut-off of 70.4 was found to differentiate GD from SAT with a sensitivity of 86% and specificity of 74%.
PLR can be used as a novel surrogate marker to differentiate between patients with GD and SAT prior to therapy, especially in resource-limited settings.
格雷夫斯病（GD）和亚急性甲状腺炎（SAT）的毒性期具有相似的临床和生化表现，鉴别两者需要复杂的检查。由于甲状腺激素已被证实会影响所有血液学细胞系，我们使用血小板淋巴细胞比率（PLR）——一种通常用于炎症或恶性疾病的指标——来比较甲状腺毒症患者和非甲状腺毒症患者，并分析其在治疗前区分GD和SAT患者中的应用。
这是一项在印度韦洛尔基督教医学院内分泌科进行的横断面研究。在研究期间，800例有甲状腺毒症特征的患者前往门诊就诊。纳入那些在诊断时进行了甲状腺放射性碘（I）摄取（RAIU）研究和全血细胞计数（CBC）的患者（N = 500）。根据RAIU值，将这些患者分为GD组（n = 354）和SAT组（n = 146）。获取基线特征、甲状腺功能测试以及CBC和PLR的各项指标。将数据与一组250例匹配的甲状腺功能正常的对照进行比较。使用SPSS 21.0软件进行分析。
与甲状腺功能正常的对照组相比，GD和SAT患者的PLR均显著降低（P = .01），GD患者的降低幅度大于SAT患者（74.5 ± 19对84.4 ± 26；P = .01）。通过对PLR进行受试者工作特征分析，发现最佳PLR截断值为70.4，用于区分GD和SAT的灵敏度为86%，特异度为74%。
PLR可作为一种新型替代标志物，用于在治疗前区分GD和SAT患者，尤其是在资源有限的环境中。
