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

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 (fT 3 /fT 4) 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 fT 3 , fT 4 , 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 fT 4 /fT 3 , Mo/Eo ratios and Mo/Eo ratio + fT 4 /fT 3 for diagnosing GD were 80.23 and 88.89, 82.56 and 60.32, and 74.4 and 87.3 with cutoff values of ≤2.841, ≤8.813 and >0.644, respectively. An equation of combined indicators including Mo, Eo, fT 3, and fT 4 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 cutoff value at 0.561 for GD diagnosis. Conclusion: Compared to regular indexes (fT 4/ fT 3 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.

Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Relation to Clinical Parameters and Smoking Status in Patients with Graves’ Orbitopathy—Novel Insight into Old Tests

“…In accordance to previous data, we proved that there were no statistically significant differences in basophil and eosinophil counts in GD patients with and without GO compared to controls [ 44 , 48 ]. Some reports suggested increased percentage of eosinophil in peripheral blood in GD patients compared to healthy individuals, but it might be associated with concomitant Th-2-predominant disorders [ 48 , 49 , 50 ].…”

New aspects in the pathogenesis and management of subacute thyroiditis

“…Many authors analyzed the usefulness of several surrogate markers based on simple blood count analysis. The potential usefulness of such parameters as platelet-lymphocyte ratio (PLR) [ 39 – 42 ], monocyte-eosinophil ratio (Mo/Eo) combined with free triiodothyronine (FT3) to free thyroxine (FT4) ratio (FT4/FT3) [ 43 ], neutrophil–lymphocyte ratio (NLR) [ 39 , 41 , 42 ] has been postulated. Taşkaldiran et al observed that in Turkish patients with SAT, PLR and NLR were significantly higher than in patients with GD, thyroid adenomas or in healthy control groups [ 39 ].…”

“…Taking into account the discrepancies in the obtained results, we can conclude that NRL and PLR can be useful in differential diagnosis of SAT and GD and in the follow up of SAT treatment, but currently no universal cut-off value can be unequivocally recommended. Hu et al evaluated other potential markers and reported that Mo/Eo and FT4/FT3 ratios were significantly higher in SAT than in GD, and the cut-off values for fT4/fT3, Mo/Eo ratios and Mo/Eo ratio + fT4/fT3 for diagnosing GD were ≤ 2.841, ≤ 8.813 and > 0.644, respectively [ 43 ]. Although still no universal cut-off values of the proposed markers can be recommended for general population, such surrogate tools might be helpful in the initial differential diagnosis of SAT in resource-limited settings.…”

Usefulness of pre-thyroidectomy neutrophil–lymphocyte, platelet–lymphocyte, and monocyte–lymphocyte ratios for discriminating lymph node and distant metastases in differentiated thyroid cancer

“…Additionally, we found that an MLR of o0.21 could discriminate distant metastasis from lymph node metastasis, with a sensibility of 80% and an accuracy of 58%. A small number of studies have demonstrated the relationship between these ratios and benign thyroid diseases such as Graves' disease (GD), Hashimoto's thyroiditis (HT), toxic adenoma (TA), and subacute thyroiditis (SAT) (26)(27)(28)(29)(30). Hu et al (28) proposed combining thyroid hormones (free thyroxine and triiodothyronine) and the eosinophil-to-monocyte ratio to distinguish GD from SAT.…”

“…A small number of studies have demonstrated the relationship between these ratios and benign thyroid diseases such as Graves' disease (GD), Hashimoto's thyroiditis (HT), toxic adenoma (TA), and subacute thyroiditis (SAT) (26)(27)(28)(29)(30). Hu et al (28) proposed combining thyroid hormones (free thyroxine and triiodothyronine) and the eosinophil-to-monocyte ratio to distinguish GD from SAT. Taskaldiran et al (30) retrospectively analyzed NLR and PLR in patients with GD, SAT, and TA and suggested that high PLR and NLR may be useful in differentiating SAT from GD and TA.…”