Introduction: Graves orbitopathy (GO) is a rare autoimmune inflammatory disease occurring in 2550% cases of Graves disease (GD). It is associated with poor clinical outcomes, impaired quality of life and socio-economic status. Genetic, environmental and immunological factors are considered to play a role in the pathogenesis of GO, but the effects of neutrophil, lymphocyte counts as well as neutrophil-to-lymphocyte ratio on the pathophysiology of GO are still unknown.
Aim of the study: The aim of this retrospective study, which based on our knowledge is the first in Poland, was to explore the connection between white blood cell, neutrophil, lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR) and the severity of GO compared with patients without thyroid-associated orbitopathy.
Subjects and methods: 110 patients (91 female and 19 male; 82.7% vs 17.3%), mean age 49±28.5 years diagnosed with GO hospitalized in the Department of Endocrinology (Lublin, Poland) in seven-year period was retrospectively analyzed. Among them 92 patients had active and 18 inactive thyroid associated-opthalmopathy. 50 patients with GD with no signs of opthalmopathy were also enrolled. The control group consisted of 50 healthy volunteers (24 female and 26 male: 48% vs 52%, aged 45±27.0 years). All patients with GO were assessed for activity of the disease using clinical activity score (CAS). Active GO was defined as CAS ≥3/7. The correlation between neutrophil/lymphocyte ratio and clinical activity of GO (spontaneous retrobulbular pain, ocular pain with eye movement, redness of the eyelids, swelling of the eyelids, redness of conjunctiva, chemosis of the conjunctiva, swelling of the caruncule) were evaluated.
Results: It has been observed that the NLR values were statistically higher in patients with or without GO (P=0.0001 vs 0.0026) compared to controls. Moreover, the NLR, WBC and neutrophil counts were higher and the lymphocyte count was lower in patients with GO than in GD patients without thyroid orbitopathy (P<0.1). There was no statistically difference (P=0.085) between NLR and the activity of GO in the clinical scale, only one of the symptoms from CAS redness of conjunctiva was positively correlated (P=0.023).
Conclusions: The results suggest that neutrophil/lymphocyte ratio may predict inflammatory process in GD patients with and without GO better than white blood cell, lymphocyte and neutrophil counts separately. However, analyzed group of patients is too small, therefore further research is needed to confirm these findings.
18 - 21 May 2019
European Society of Endocrinology