Eosinophil/Monocyte Ratio Combined With Serum Thyroid Hormone for Distinguishing Graves' Disease and Subacute Thyroiditis.

Yongbin Hu,Diyi Zhou,Pengfei Shan,Jiawei Chen

doi:10.3389/fendo.2020.00264

Abstract

Background: Thyrotoxicosis is commonly classified into several entities according to different etiologies. Identifying the causes of thyroid dysfunction is critical for the subsequent selection of treatment. The free triiodothyronine to free thyroxine ratio (fT3/fT4) is widely used but is still a controversial diagnostic measurement.Methods: A total of 290 patients including 141 healthy control subjects, 86 patients with untreated Graves' disease (GD,) and 63 patients with subacute thyroiditis (SAT) were enrolled in the study. The main aim was to evaluate the diagnostic value of different indexes from serum testing including fT3, fT4, eosinophils (Eo) and monocytes (Mo). The diagnostic performance of multiple indexes was evaluated separately using receiver operating characteristic curve analysis.Results: Sensitivities and specificities of fT4/fT3, Mo/Eo ratios and Mo/Eo ratio + fT4/fT3 for diagnosing GD were 80.23 and 88.89, 82.56 and 60.32, and 74.4 and 87.3 with cut-off values of ≤ 2.841, ≤ 8.813 and >0.644, respectively. An equation of combined indicators including Mo, Eo, fT3, and fT4 data was developed to calculate a probability value and among all indexes studied the indicator combination formula gave the best diagnostic value, reaching sensitivity and specificity of 89.53 and 90.48%, respectively, with an optimum cut-off value at 0.561 for GD diagnosis.Conclusion: Compared to regular indexes (fT4/fT3 and Mo/Eo), a newly developed indicator combination formula provided a higher prediction probability and may serve as a simple, cost-effective tool for differentiating GD from SAT patients, especially in undeveloped regions of China.

Highlights

Thyrotoxicosis is an excess of thyroid hormones in the blood caused by a common thyroid dysfunction
Graves’ disease (GD) is usually diagnosed on the basis of clinical findings and laboratory tests showing high values of the free triiodothyronine to free thyroxine ratio, low levels of thyroid-stimulating hormone (TSH), and/or high radioactive iodine uptake (RAIU) as well as TSH-receptor stimulating antibodies
There was no significant differences between males and females regarding Mo (%), Eo (%), fT3, fT4, fT4/fT3 and Mo/Eo in the 3 groups and the differences between GD and subacute thyroiditis (SAT) patients did not show gender specifities (Supplementary Table 1)

Summary

Introduction

Thyrotoxicosis is an excess of thyroid hormones in the blood caused by a common thyroid dysfunction. Graves’ disease (GD) and subacute thyroiditis (SAT) are two of the most common etiologies of thyrotoxicosis, along with others including toxic adenoma and multinodular goiter [2]. GD is usually diagnosed on the basis of clinical findings and laboratory tests showing high values of the free triiodothyronine (fT3) to free thyroxine (fT4) ratio (fT3/fT4), low levels of TSH, and/or high radioactive iodine uptake (RAIU) as well as TSH-receptor stimulating antibodies. Methods: A total of 290 patients including 141 healthy control subjects, 86 patients with untreated Graves’ disease (GD,) and 63 patients with subacute thyroiditis (SAT) were enrolled in the study. The main aim was to evaluate the diagnostic value of different indexes from serum testing including fT3, fT4, eosinophils (Eo) and monocytes (Mo). The diagnostic performance of multiple indexes was evaluated separately using receiver operating characteristic curve analysis

Objectives

Methods

Results

Conclusion