The relationship between inflammatory parameters in hemogram and thyroid stimulating immunoglobulin (TSI) level at the beginning and at the 6th month of treatment in graves' disease

Introduction and aim: Graves' disease (GD) is an autoimmune thyroid disease characterized by diffuse goiter and hyperthyroidism. TSI is used in the differential diagnosis of thyrotoxicosis, disease recurrence and activity. However, accessibility and cost limit the use of TSI. In our study, we investigated the availability of easily accessible markers that can be used instead of TSI in the diagnosis and follow-up of GD. We aimed to evaluate the relationship between inflammatory markers such as NLO, MLO, TLO, SII index, PIV and TSI levels obtained from complete blood count at baseline and 6 months after antithyroidal therapy. Materials and Methods: Between June 2018 and June 2023, 162 patients with GD who were followed up in Celal Bayar University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases outpatient clinic were retrospectively analyzed. Patients with acute or chronic infections, hematologic and rheumatologic diseases, history of malignancy, pregnant women, and patients who were not available for follow-up were excluded. According to free T4 level, patients were divided into 3 groups as mild, moderate and severe disease. Thyroid function tests, hemogram parameters and TSI values at the time of diagnosis and after 6 months of antithyroid therapy were compared. The correlation of the statistically significant parameters with TSI was analyzed separately for each group. Results: A total of 162 patients (108 women (66.7%) and 54 men (33.3%) diagnosed with GD who were followed up in our Endocrinology Outpatient Clinic of Celal Bayar University Faculty of Medicine between 2018 and 2023 were included in the study. The age of these patients ranged between 18 and 83 years with a mean age of 42.68 ± 15.33 years. Hemoglobin (p=0.009), leukocytes (p=0.001), neutrophils (p=0.002), lymphocytes (p=0.002), eosinophils (p=0.033), basophils (p=0.001) and TSH (p=0. 001) were significantly increased, while monocytes (p=0.003), platelets (p=0.010), TLO (p=0.001), MLO (p=0.001), sT3 (p=0.001), sT4 (p=0.001) were significantly decreased. The correlation of these statistically significant parameters with TSI was analyzed. When baseline and 6-month post-treatment values were analyzed in all patients, a very weak positive correlation was found between TSI and monocytes and MLO and a weak positive correlation was found with sT3. In the severe disease group, a weak positive correlation was found between TSI and RDW and sT3. Conclusion: Although no reliable marker that can be used as an alternative to TSI in the follow-up of Graves' disease has been found, monocytes, MLO and RDW in severe patients may give an idea about the disease activitiy during follow up. Key Words: Graves disease, Inflammatory parameters, Thyroid Stimulating Immunglobulın