Significant role of serum CRP in differentiating inflammatory from non-inflammatory causes of thyrotoxicosis

Abstract

Background:C-reactive protein (CRP), which is a marker of inflammation, has not been widely studied in inflammatory thyroid disorders particularly in sub-acute thyroiditis (SAT).Aim:This study was aimed to find the significance of CRP level rise in patients with SAT and compare that to the rise in erythrocyte sedimentation rate (ESR), a gold standard laboratory parameter in establishing the diagnosis of SAT.Materials and Methods:Serum CRP levels were measured at initial presentation in 28 subjects with SAT(12 male, 16 female, age (Mean +SD) 37.96 ±8.5 years),and 19 patients with Graves’ disease (2 male, 17 female, age [Mean +SD] 36.8 ±16.5 years) as controls. Erythrocyte sedimentation rate (ESR) was measured in all 28 patients with SAT by Westergrens’ method. Either Tc99 nucleotide thyroid scan or high resolution ultrasonography (HR-USG) was performed to differentiate SAT from Graves’ disease.Fine needle aspiration cytology (FNAC) of thyroid was performed selected patients.Results:Serum CRP level was high in 61% of SAT patients but in none of the Graves′patients. Mean (SEM) (90%CI) serum CRP level (mg/L) was also significantly higher (P <0.0004) in the SAT group [27.55 (5.76) (15.72-39.38)], than in the Graves’ group [4.09 (0.12) (3.81-4.36)]. The sensitivity of serum CRP was 73.33%, specificity 53.85%, positive predictive value (PPV) 64.71%, and negative predictive value (NPV) 63.64% as compared to the sensitivity (53.57%), specificity (15.38%), PPV (57.69 %), and NPV (13.33%) of ESR.Conclusion:There is significantly higher rise in serum CRP level in patients with SAT is compared to patients with Graves’ disease. It correlates well with the rise in ESR. Such findings of this pilot study highlight the scope of using serum CRP as a diagnostic marker of SAT specially in situations when it may be confused with Graves’ disease, another common cause of thyrotoxicosis. It is logical to carry out studies to find a particular cut-off for serum CRP which can serve as an objective parameter for grading the inflammation in patients with SAT.

Technetium-99m thyroid scintigraphy and human leukocyte antigen – B35 in sub-acute thyroiditis

“…[ 15 ] ESR and CRP levels, markers of acute inflammation, were relatively lower in our study when compared to 90%–100% elevated levels in studies of Das,[ 14 ] Hamburger et al .,[ 16 ] and Baruah et al . [ 11 ] We attribute this unusual feature in our patients to reporting later in the acute phase of the disease. Expectedly, the lower mean TSH and higher mean FT4 levels were reported in an overwhelming majority of patients in this study, and this was in conformity with previous published studies of Benbassat et al .,[ 17 ] Qari et al .,[ 18 ] and Mahar et al .…”

“…in 2003 though their female-to-male ratio of 3.5:1 was slightly higher. [ 10 ] The mean age at presentation of 36.96 ± 12.17 years in the present study is more or less similar to 37.96 ± 8.5, 41.2 ± 11.2, and 37.2 ± 12.4 years in other published studies by Barhua et al .,[ 11 ] Mahar et al .,[ 12 ] and Kalra et al .,[ 13 ] respectively, though most of them like our study are based on Asian population. The mean age of 46 years at presentation from the published western data of Minnesota in the US is higher.…”

Sub Acute Thyroiditis in a Case of West Nile Virus (WNV) Infection

“…There are no reports that describe WNV as the etiological factor for sub acute thyroiditis, and we are presenting the first case report that shows an association between WNV and thyroiditis. As for the diagnosis of sub acute thyroiditis and to differentiate it from auto immune thyroiditis -there is epidemiological evidence that patients with sub acute thyroiditis have higher serum CRP levels compared with patients with autoimmune thyroiditis [5].…”

Immune System Sex Differences May Bridge the Gap Between Sex and Gender in Fibromyalgia

“…The latter only indicates that FMS is not cyclooxygenase dependent, but discredits neither the involvement of other inflammatory and immune response pathways, nor does it nullify the possibility of neurogenic pain. Failure to comply with inflammatory criteria have not prevented the recognition of Graves' disease (Baruah and Bhattacharya, 2012) and MS as autoimmune diseases (Luzzio and Dangond, 2018). Furthermore, the need for inflammatory biomarkers does not apply to secondary FMS because the accompanying autoimmune disease will generate not only inflammatory biomarkers but also a continuous nociceptive input.…”