Immature granulocytes and neutrophil-to-lymphocyte ratio as markers of treatment response in subacute thyroiditis

Topuz, Emek; Tüzün, Dilek; Şahin, Murat

doi:10.20945/2359-4292-2023-0012

Brasil

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ORIGINAL ARTICLE • Arch. Endocrinol. Metab. 68 • 2024 • https://doi.org/10.20945/2359-4292-2023-0012 linkcopy

Immature granulocytes and neutrophil-to-lymphocyte ratio as markers of treatment response in subacute thyroiditis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective Subacute thyroiditis is also known as subacute granulomatous thyroiditis, giant cell thyroiditis, painful thyroiditis, and De Quervain’s thyroiditis. Immature granulocytes (IG) and neutrophil-to-lymphocyte ratio (NLR) are new inflammatory markers that are easily detected in routine complete blood count (CBC) tests. The aim of this study was to investigate the role of IG and NLR as markers of treatment response in patients with subacute thyroiditis.

Subjects and methods The study included 41 patients with subacute thyroiditis treated and monitored in our outpatient clinic between April 2020 and April 2022. From a retrospective review of medical records, we recorded results of IG, NLR, thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) from blood tests obtained routinely before and after treatment.

Results Overall, 31 (75.6%) patients were women and 10 (21.4%) were men. The median age was 41 years (range 22-68 years). The laboratory tests showed the following median (range) results: IG, 0.03 (0.01-0.08); NLR, 3.6 (1.2-5.2); TSH, 0.02 mIU/L (0.01-3.35 mIU/L); fT4, 2.3 ng/dL (1.0-7.0 ng/dL); fT3, 5.6 pmol/L (2.6-15.2 pmol/L); ESR, 49 mm/h (17.0-87 mm/h); and CRP, 73 mg/dL (3.0-188 mg/dL).

Conclusion Early diagnosis and treatment of subacute thyroiditis is fundamental. In the present study, the new inflammatory markers IG and NLR, measured routinely on CBC tests, decreased significantly after subacute thyroiditis treatment relative to pretreatment values. After treatment, the NLR change correlated with ESR and CRP changes, while the IG change correlated only with CRP change. These findings suggest that the markers IG and NLR may be used to evaluate treatment response in patients with subacute thyroiditis.

Keywords Subacute thyroiditis; neutrophil to lymphocyte ratio; immature granulocyte

Characteristics	Results
Age	41 (²²-68), 41.5 ± 8.6
Sex
Female	31 (75.6%)
Male	10 (24.4%)
RAIU (% uptake)	0.10 (0.01-2.80), 0.33 ± 0.75
TSH (mIU/L)	0.02 (0.01-3.35), 0.36 ± 0.81
fT4 (ng/dL)	2.3 (1.0-7.0), 2.5 ± 1.2
fT3 (pmol/L)	5.6 (2.6-15.2), 6.2 ± 2.7
ESR (mm/h)	49.0 (17.0-87.0), 50.7 ± 19.2
CRP (mg/dL)	73.0 (3.0-188.0), 75.6 ± 51.6
NLR	3.6 (1.2-5.2), 3.3 ± 1.1
IG	0.03 (0.01-0.08), 0.04 ± 0.02
Pain	41 (100.0%)
COVID-19 in the previous month	10 (24.4%)
No COVID-19 in the previous month	9 (22.0%)
COVID-19 vaccine in the previous month	2 (4.9%)
Site of inflammation (ultrasound)
Right lobe	12 (29.3%)
Left lobe	2 (4.9%)
Both lobes	27 (65.9%)
Development of hypothyroidism	9 (22.0%)
Use of levothyroxine	6 (14.6%)
Corticosteroid treatment	25 (61.0%)
NSAID treatment	16 (39.0%)

	Pretreatment				Posttreatment				p

	Min-max			Median	Min-max			Median
TSH (mIU/L)	0.0	–	3.4	0.0	0.7	–	14	2.00	<0.001*
fT4 (ng/dL)	1.0	–	7.0	2.3	0.9	–	1.7	1.1	<0.001*
fT3 (pmol/L)	2.6	–	15.2	5.6	2.2	–	3.8	3.0	<0.001*
ESR (mm/h)	17	–	87	49.0	2.0	–	19	5.0	<0.001*
CRP (mg/dL)	3.0	–	188	73.0	1.4	–	11	3.2	<0.001*
NLR	1.2	–	5.2	3.6	0.7	–	3.2	1.7	<0.001*
IG	0.01	–	0.08	0.03	0.01	–	0.06	0.01	<0.001*

	NSAID treatment		Corticosteroid treatment		P values

	Mean ± SD	Median	Mean ± SD	Median
TSH
Pretreatment	0.46 ± 0.84	0.03	0.30 ± 0.81	0.02	0.879^‡
Posttreatment	3.10 ± 3.13	2.06	2.89 ± 2.13	2.00	0.989^‡
Change^*	2.64 ± 3.45	1.87	2.59 ± 2.17	1.91	0.810^‡
P values^†	0.003^¶		<0.001^¶
fT4
Pretreatment	2.25 ± 0.98	2.25	2.72 ± 1.34	2.37	0.279^‡
Posttreatment	1.19 ± 0.19	1.15	1.17 ± 0.17	1.10	0.702^‡
Change^*	-1.06 ± 0.98	-0.80	-1.55 ± 1.30	-1.27	0.095^‡
P values^†	0.001^¶		<0.001^¶
fT3
Pretreatment	5.4 ± 2.4	5.3	6.8 ± 2.7	6.0	0.068^‡
Posttreatment	2.8 ± 0.3	2.8	3.0 ± 0.4	3.1	0.177^‡
Change^*	-2.5 ± 2.4	-2.5	-3.7 ± 2.7	-2.8	0.925^‡
P values^†	0.001^¶		<0.001^¶
ESR
Pretreatment	49.1 ± 16.5	50.0	51.6 ± 21.0	45.0	0.925^‡
Posttreatment	7.4 ± 4.6	5.5	5.7 ± 3.2	4.0	0.165^‡
Change^*	-41.8 ± 16.0	-42.0	-45.9 ± 20.7	-40.0	0.584^‡
P values^†	<0.001^¶		<0.001^¶
CRP
Pretreatment	64.6 ± 49.9	64.0	82.6 ± 52.4	75.0	0.285^‡
Posttreatment	4.0 ± 2.3	3.2	4.1 ± 2.2	3.2	0.610^‡
Change^*	-60.7 ± 48.7	-60.7	-78.4 ± 51.8	-69.1	0.250^‡
P values^†	<0.001^¶		<0.001^¶
NLR
Pretreatment	3.43 ± 1.24	3.90	3.27 ± 1.05	3.30	0.649^§
Posttreatment	1.95 ± 0.72	2.00	1.76 ± 0.64	1.50	0.380^§
Change^*	-1.48 ± 0.71	-1.41	-1.51 ± 0.89	-1.30	0.919^§
P values^†	<0.001^#		<0.001^#
IG
Pretreatment	0.04 ± 0.02	0.04	0.04 ± 0.02	0.03	0.989^‡
Posttreatment	0.02 ± 0.01	0.01	0.02 ± 0.01	0.02	0.484^‡
Change^*	-0.02 ± 0.02	-0.02	-0.02 ± 0.02	-0.02	1.000^‡
P values^†	0.002^¶		<0.001^¶

		ESR	CRP
Pretreatment
NLR	r	0.298	0.452
NLR	p	0.058	0.003
IG	r	0.277	0.397
IG	p	0.080	0.010
Posttreatment
NLR	r	0.254	0.428
NLR	p	0.109	0.005
IG	r	-0.048	0.134
IG	p	0.763	0.405
Posttreatment change
NLR	r	0.351	0.493
NLR	p	0.024	0.001
IG	r	0.223	0.352
IG	p	0.161	0.024

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[TFN1] The results are shown as numbers (percentages), median (minimum-maximum) values, or mean ± standard deviation values. Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; fT3, free triiodothyronine; fT4, free thyroxine; IG, immature granulocytes; NLR, neutrophil-to-lymphocyte ratio; NSAIDs, nonsteroidal antiinflammatory drugs; RAIU, radioiodine uptake; TSH, thyroid-stimulating hormone.