Neutrophil- and Platelet- to Lymphocyte Ratio in Patients with Euthyroid Hashimoto’s Thyroiditis

Abstract

Background Hashimoto's thyroiditis (HT) is the most prevalent autoimmune thyroid disorder. Both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are reported to be increased in various inflammation-related diseases, but their clinical significance in HT remains unclear.

Objectives The aim of this study was to investigate the relationship between thyroid autommunity and NLR and PLR as markers of systemic inflammation in HT.

Methods In this study, we evaluated 145 women with HT and 60 age-matched healthy controls. We compared the PLR and the NLR of HT patients with controls and the correlation between the NLR, PLR, and C-reactive protein (CRP), thyroid-stimulating hormone (TSH) and thyroid antibody titers in the patient group. Also we compared the PLR and the NLR of HT patients that received levothyroxine with those who did not receive levothyroxine

Results There were no significant differences between patient and control groups in terms of overall leukocyte counts, neutrophil counts, and other laboratory tests. In the patient group lymphocyte counts were lower while the platelet counts, NLR (2.29±0.65 vs1.68±0.40), PLR (164.95±55.14 vs106.88±32.19) were higher than those of the control (p<0.001 for all comparisons).

Conclusion In this study we found that NLR and PLR were higher in euthyroid Hashimoto patients than in a healthy control group. NLR and PLR are likely non-specific indicators of immune disorder and their implications for HT and other conditions remain to be elucidated.

Key words

NLR - PLR - Hashimoto’s thyroiditis

• References

• 1 Garber JR, Cobin RH, Gharib H. et al. Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. EndocrPract 2012; 18: 989-1028
• 2 Ganesh BB, Bhattacharya P, Gopisetty A. et al. Role of cytokines in the pathogenesis and supression of thyroid autoimmunity. J Interferon Cytokine Res 2011; 31: 721-731
• 3 Fu H, Qin B, Hu Z. et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab. 2015; 61: 269-273
• 4 Qin B, Ma N, Tang Q. et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016; 26: 372-376
• 5 Ahsen A, Ulu MS, Yuksel S. et al. As a new inflammatory marker for familial Mediterranean fever: Neutrophil-to-lymphocyte ratio. Inflammation 2013; 36: 1357-1362
• 6 Acarturk G, Kaya A, Demir K. et al. Neutrophil-to-lymphocyte ratio in inflammatory bowel disease - As a new predictorof disease severity. BratislLekListy 2015; 116: 213-217
• 7 Templeton AJ, McNamara MG, Šeruga B. et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: A systematic review and meta-analysis. J Natl Cancer Inst 2014; 29: dju124
• 8 Guthrie GJ, Charles KA, Roxburgh CS. et al. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev OncolHematol 2013; 88: 218-230
• 9 Lang BH, Ng CP, Au KB. et al. Does preoperative neutrophil lymphocyte ratio predict risk of recurrence and occult central nodal metastasis in papillary thyroid carcinoma?. World J Surg 2014; 38: 2605-2612
• 10 Kim JY, Park T, Jeong SH. et al. Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas. Endocrine 2014; 46: 526-531
• 11 Turkmen K. Platelet-to-lymphocyte ratio: One of the novel and valuable platelet indices in hemodialysis patients. Hemodial Int. 2013; 17: 670
• 12 Li H, Zhou Y, Ma Y. et al. The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: A systematic review and meta-analysis. Kardiol Pol. 2017; 75: 666-673
• 13 Poplawska-Kita A, Kosciuszko-Zdrodowska M, Siewko K. et al. High serum Ig G4 concentrations in patients with Hashimoto’s Thyroiditis. Int J Endocrinol 2015; e706843
• 14 Zaletel K, Gaberscek S. Hashimoto’s thyroiditis: From genes to the disease. Curr Genomics 2011; 12: 576-588
• 15 Kaplan MJ. Role of neutrophils in systemic autoimmune diseases. Arthritis Res Ther 2013; 15: 219-228
• 16 Keskin H, Kaya Y, Cadirci K. et al. Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyrotidis. EndocrRegul 2016; 50: 148-153
• 17 Aksu O, Aydın B, Koroglu BK. et al. An evaluatıon of the neutrophıl/lymphocyte ratıo ın patıents wıth hashimoto’s thyroıdıtıs. ActaMedicaMediterranea 2014; 30: 457
• 18 Sen BB, Rifaioglu EN, Ekiz O. et al. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. CutanOculToxicol 2014; 33: 223-227
• 19 Chandrashekara S, Rajendran A, Bai Jaganath A. et al. Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis. Reumatismo. 2015; Dec 30 67: 109-115
• 20 Torun S, Tunc BD, Suvak B. et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: A promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012; Oct 36: 491-497
• 21 Uslu AU, Deveci K, Korkmaz S. et al. Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever?. Biomed Res Int 2013; 2013: 185317
• 22 Ozmen S, Timur O, Calik I. et al. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio(PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer. EndocrRegul 2017; 51: 131-136
• 23 Metineren H, Dülgeroğlu TC. Comparison of the neutrophil/lymphocyte ratio and c-reactive protein levels in patients with amputation for diabetic foot ulcers. Int J Low Extrem Wounds 2017; 16: 23-28
• 24 Tanrıverdi H, Örnek T, Erboy F. et al. Comparison of diagnostic values of procalcitonin, C-reactive protein and blood neutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD. Wien KlinWochenschr 2015; 127: 756-763
• 25 Karanikas G, Schuetz M, Wahl K. et al. Relation of anti-TPO autoantibody titre and T-lymphocyte cytokine production patterns in Hashimoto's thyroiditis. ClinEndocrinol (Oxf) 2005; 63: 191-196
• 26 Marchiori RC, Pereira LA, Naujorks AA. et al. Improvement of blood inflammatory marker levels in patients with Hypothyroidism under levothyroxine treatment. BMC EndocrDisord 2015; 15: 32
• 27 Guclu F, Ozmen B, Kirmaz C. et al. Down-regulation of the auto-aggressive processes in patients with hypothyroid Hashimoto's thyroiditis following substitutive treatment with L-thyroxine. Eur Cytokine Netw 2009; 20: 27-32