Abstract
Graves’ orbitopathy (GO) is an autoimmune disease with a chronic inflammatory background. Smoking behavior is the main environmental factor responsible for the transition of this major extra thyroidal manifestation of Graves’ disease (GD) from the subclinical to the overt form. Complete blood count-derived parameters are suggested to be novel inflammatory indices. The aim of this retrospective study was to investigate the association between neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte ratios (PLR) with selected clinical parameters and smoking status in 406 GD patients with (n = 168) and without GO (n = 238). The control group consisted of 100 healthy individuals. The activity of GO was graded according to Clinical Activity Score. Significantly higher white blood cells (WBC), neutrophil, and NLR (p < 0.05) values were observed in GD patients with GO compared with those without GO. PLR values were significantly higher in GO patients than in the controls. WBC (6.81 ± 1.56 vs. 5.70 ± 1.23) and neutrophils (3.89 ± 1.06 vs. 3.15 ± 0.95) count was higher in active GO patients than in those with inactive GO. Positive correlation (p < 0.05) between CAS score and WBC, neutrophil and monocyte count, and NLR was found. Smoking was associated with higher WBC (p = 0.040), neutrophil (p = 0.049), PLR (p = 0.032) values. Multivariate analysis revealed that WBC, NLR may be risk factors for GO development. WBC, neutrophil, NLR and PLR values seem to be useful tools in the assessment of inflammation in GD.
Highlights
Graves’ orbitopathy (GO) constitutes the major extra thyroidal manifestation of Graves’ disease (GD)
Similar results were obtained by Celik et al, who revealed that both white blood cells (WBC), neutrophil, lymphocyte counts and neutrophil-to-lymphocyte ratio (NLR) values were significantly higher in the group of patients with GO compared with the controls [28]
In the present study we revealed that NLR values and WBC counts may be factors increasing the risk of GO in GD patients with OR 1.348 and OR 1.209, respectively, and that is why these hematological parameters can be additional tools to determine the risk of GO occurrence, beside assessing smoking habits
Summary
Graves’ orbitopathy (GO) constitutes the major extra thyroidal manifestation of Graves’ disease (GD). GO is an autoimmune inflammatory disorder affecting orbital soft tissue, which may lead to the visual disturbances due to extraocular muscle involvement, proptosis, conjunctival inflammation and oedema [1,2]. GO occurs in case of Graves’ hyperthyroidism (90%), it may be seen in euthyroid (7%) or hypothyroid (3%) patients as a result of chronic autoimmune (Hashimoto) thyroiditis [3]. The clinical course of GO is commonly mild to moderate, and the incidence of severe sight-threatening form ranges from 3 to 5%. It is well established that about 25–35% GD hyperthyroid patients develop clinically manifest GO, the recent studies revealed that subclinical eye involvement is observed in radiological examinations in nearly 65–75% individuals [3,4]. There is a great need to investigate early biomarkers to identify GD patients with high risk of GO development
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