Comparison of Mean Platelet Volume, Platelet Count, Neutrophil/ Lymphocyte Ratio and Platelet/Lymphocyte Ratio in the Euthyroid, Overt Hypothyroid and Subclinical Hyperthyroid Phases of Papillary Thyroid Carcinoma

Author(s): Faruk Kutluturk* , Serdar S. Gul , Safak Sahin , Turker Tasliyurt .

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets

Volume 19 , Issue 6 , 2019

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Abstract:

Introduction: Thyroid hormones are essential for the normal development, differentiation, metabolic balance and physiological function of all tissues. Mean platelet volume (MPV) indicates mean platelet size and reflects platelet production rate and stimulation. Increased platelet size has been observed in association with known cardiovascular risk factors. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are known markers of the systemic inflammatory response. This study aimed to investigate the effect of thyroid hormone changes by comparing platelet count, MPV values, NLR and PLR in thyroid papillary carcinoma.

Methods: Forty-nine females and nine males comprising a total of 58 patients were included in the study. Clinical and laboratory parameters of patients were recorded in the following three phases of the disease: euthyroid phase (before thyroid surgery), overt hypothyroid (OH) phase (before radioactive iodine [RAI] treatment) and subclinical hyperthyroid (SCH) phase (six months after RAI treatment).

Results: The mean thyroid-stimulating hormone (TSH) values of the patients in the euthyroid, OH and SCH phases were 1.62±1.17, 76.4±37.5 and 0.09±0.07 µIU/mL, respectively. The mean MPV values of the patients in the euthyroid, OH and SCH phases were 9.45±1.33, 9.81±1.35 and 9.96±1.21 fL, respectively. MPV was significantly higher in the SCH phase than in the euthyroid phase (p=0.013). Platelet count, NLR and PLR were not statistically different between the euthyroid, OH and SCH phases.

Conclusion: The results of this study demonstrated that the levels of MPV increased significantly in the SCH phase in patients with papillary thyroid carcinoma (PTC), and increased MPV values contributed to increased risk of cardiovascular complications. These findings suggest that MPV can be a valuable, practical parameter for monitoring the haemostatic condition in thyroid disorders. No significant difference was observed in platelet count, NLR and PLR in all stages of PTC.

Keywords: Hypothyroidism, hyperthyroidism, mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet count.

[1]
Bashir, H.; Bhat, M.H.; Farooq, R.; Majid, S.; Shoib, S.; Hamid, R.; Mattoo, A.A.; Rashid, T.; Bhat, A.A.; Wani, H.A.; Masood, A. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Med. J. Islam. Repub. Iran, 2012, 26(4), 172-178.
[PMID: 23482519]
[2]
Iddah, M.A.; Macharia, B.N.; Ng’wena, A.G.; Keter, A.; Ofulla, A.V. Thryroid hormones and hematological indices levels in thyroid disorders patients at moi teaching and referral hospital, Western kenya. ISRN Endocrinol., 2013, 2013(15)385940
[http://dx.doi.org/10.1155/2013/385940] [PMID: 23691348]
[3]
Franchini, M.; Montagnana, M.; Manzato, F.; Vescovi, P.P. Thyroid dysfunction and hemostasis: an issue still unresolved. Semin. Thromb. Hemost., 2009, 35(3), 288-294.
[http://dx.doi.org/10.1055/s-0029-1222607] [PMID: 19452404]
[4]
Dorgalaleh, A.; Mahmoodi, M.; Varmaghani, B.; Kiani Node, F.; Saeeidi Kia, O.; Alizadeh, Sh.; Tabibian, Sh.; Bamedi, T.; Momeni, M.; Abbasian, S.; Kashani Khatib, Z. Effect of thyroid dysfunctions on blood cell count and red blood cell indice. Iran. J. Ped. Hematol. Oncol., 2013, 3(2), 73-77.
[PMID: 24575274]
[5]
Kawa, M.P.; Grymuła, K.; Paczkowska, E.; Baśkiewicz-Masiuk, M.; Dąbkowska, E.; Koziołek, M.; Tarnowski, M.; Kłos, P.; Dziedziejko, V.; Kucia, M.; Syrenicz, A.; Machalinski, B. Clinical relevance of thyroid dysfunction in human haematopoiesis: biochemical and molecular studies. Eur. J. Endocrinol., 2010, 162(2), 295-305.
[http://dx.doi.org/10.1530/EJE-09-0875] [PMID: 19903799]
[6]
Alcelik, A.; Aktas, G.; Eroglu, M.; Tosun, M.; Savli, H.; Dikbas, O.; Zeyrek, A.; Yalcin, A. Platelet function in euthyroid patients undergoing thyroidectomy in women. Eur. Rev. Med. Pharmacol. Sci., 2013, 17(17), 2350-2353.
[PMID: 24065229]
[7]
Myrup, B.; Bregengård, C.; Faber, J. Primary haemostasis in thyroid disease. J. Intern. Med., 1995, 238(1), 59-63.
[http://dx.doi.org/10.1111/j.1365-2796.1995.tb00899.x] [PMID: 7541829]
[8]
Ford, H.C.; Carter, J.M. Haemostasis in hypothyroidism. Postgrad. Med. J., 1990, 66(774), 280-284.
[http://dx.doi.org/10.1136/pgmj.66.774.280] [PMID: 2201013]
[9]
Franchini, M.; Lippi, G.; Manzato, F.; Vescovi, P.P.; Targher, G. Hemostatic abnormalities in endocrine and metabolic disorders. Eur. J. Endocrinol., 2010, 162(3), 439-451.
[http://dx.doi.org/10.1530/EJE-09-0958] [PMID: 19934268]
[10]
Lima, C.S.P.; Zantut Wittmann, D.E.; Castro, V.; Tambascia, M.A.; Lorand-Metze, I.; Saad, S.T.; Costa, F.F. Pancytopenia in untreated patients with Graves’ disease. Thyroid, 2006, 16(4), 403-409.
[http://dx.doi.org/10.1089/thy.2006.16.403] [PMID: 16646688]
[11]
Panzer, S.; Haubenstock, A.; Minar, E. Platelets in hyperthyroidism: studies on platelet counts, mean platelet volume, 111-indium-labeled platelet kinetics, and platelet-associated immunoglobulins G and M. J. Clin. Endocrinol. Metab., 1990, 70(2), 491-496.
[http://dx.doi.org/10.1210/jcem-70-2-491] [PMID: 2298861]
[12]
Yilmaz, H.; Ertuğrul, O.; Ertuğrul, B.; Ertuğrul, D. Mean platelet volume in patients with subclinical hypothyroidism. Platelets, 2011, 22(2), 143-147.
[http://dx.doi.org/10.3109/09537104.2010.508130] [PMID: 21265598]
[13]
Threatte, G.A. Usefulness of the mean platelet volume. Clin. Lab. Med., 1993, 13(4), 937-950.
[http://dx.doi.org/10.1016/S0272-2712(18)30418-9] [PMID: 8313690]
[14]
Mangalpally, K.K.; Siqueiros-Garcia, A.; Vaduganathan, M.; Dong, J.F.; Kleiman, N.S.; Guthikonda, S. Platelet activation patterns in platelet size sub-populations: differential responses to aspirin in vitro. J. Thromb. Thrombolysis, 2010, 30(3), 251-262.
[http://dx.doi.org/10.1007/s11239-010-0489-x] [PMID: 20502945]
[15]
Carlioglu, A.; Timur, O.; Durmaz, S.A.; Ayhan, M.E. Mean platelet volume in euthyroid patients with Hashimoto’s thyroiditis. Blood Coagul. Fibrinolysis, 2015, 26(3), 282-284.
[http://dx.doi.org/10.1097/MBC.0000000000000236] [PMID: 25485785]
[16]
Nadar, S.; Blann, A.D.; Lip, G.Y. Platelet morphology and plasma indices of platelet activation in essential hypertension: effects of amlodipine-based antihypertensive therapy. Ann. Med., 2004, 36(7), 552-557.
[http://dx.doi.org/10.1080/07853890410017386] [PMID: 15513305]
[17]
Pathansali, R.; Smith, N.; Bath, P. Altered megakaryocyte-platelet haemostatic axis in hypercholesterolaemia. Platelets, 2001, 12(5), 292-297.
[http://dx.doi.org/10.1080/09537100120058810] [PMID: 11487381]
[18]
Gasparyan, A.Y.; Ayvazyan, L.; Mikhailidis, D.P.; Kitas, G.D. Mean platelet volume: a link between thrombosis and inflammation? Curr. Pharm. Des., 2011, 17(1), 47-58.
[http://dx.doi.org/10.2174/138161211795049804] [PMID: 21247392]
[19]
Coban, E.; Ozdogan, M.; Yazicioglu, G.; Akcit, F. The mean platelet volume in patients with obesity. Int. J. Clin. Pract., 2005, 59(8), 981-982.
[http://dx.doi.org/10.1111/j.1742-1241.2005.00500.x] [PMID: 16033624]
[20]
Lippi, G.; Danese, E.; Montagnana, M.; Nouvenne, A.; Meschi, T.; Borghi, L. Mean platelet volume is significantly associated with serum levels of thyroid-stimulating hormone in a cohort of older euthyroid subjects. Endocr. Res., 2015, 40(4), 227-230.
[http://dx.doi.org/10.3109/07435800.2015.1037392] [PMID: 26167760]
[21]
Uysal, E.; Ceylan, S.M.; Sezgin, E.; Bakir, H.; Gurer, A.O.; Aksoy, B.; Bastemir, M. Evaluation of Hemocytometer Parameters as Potential Biomarkers in Benign Multinodular Goiter and Papillary Thyroid Carcinoma. Iran. Red Crescent Med. J., 2017, 19(12)e58295
[http://dx.doi.org/10.5812/ircmj.58295]
[22]
Machairas, N.; Kostakis, I.D.; Prodromidou, A.; Stamopoulos, P.; Feretis, T.; Garoufalia, Z.; Damaskos, C.; Tsourouflis, G.; Kouraklis, G. Trends in white blood cell and platelet indices in a comparison of patients with papillary thyroid carcinoma and multinodular goiter do not permit differentiation between the conditions. Endocr. Res., 2017, 42(4), 311-317.
[http://dx.doi.org/10.1080/07435800.2017.1319859] [PMID: 28506088]
[23]
Liu, J.F.; Ba, L.; Lv, H.; Lv, D.; Du, J.T.; Jing, X.M.; Yang, N.J.; Wang, S.X.; Li, C.; Li, X.X. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci. Rep., 2016, 6(6), 38551.
[http://dx.doi.org/10.1038/srep38551] [PMID: 27941815]
[24]
Miccoli, P.; Bakkar, S. Surgical management of papillary thyroid carcinoma: an overview. Updates Surg., 2017, 69(2), 145-150.
[http://dx.doi.org/10.1007/s13304-017-0449-5] [PMID: 28405952]
[25]
Cramer, J.D.; Fu, P.; Harth, K.C.; Margevicius, S.; Wilhelm, S.M. Analysis of the rising incidence of thyroid cancer using the Surveillance, Epidemiology and End Results national cancer data registry. Surgery, 2010, 148(6), 1147-1152.
[http://dx.doi.org/10.1016/j.surg.2010.10.016] [PMID: 21134545]
[26]
Bagir, G.S.; Haydardedeoglu, F.E.; Bakiner, O.S.; Bozkirli, E.; Ertorer, M.E. Mean Platelet Volume in Graves’ disease: A Sign of Hypermetabolism Rather than Autoimmunity? Pak. J. Med. Sci., 2017, 33(4), 871-875.
[PMID: 29067056]
[27]
Ren, X.; Meng, Z.; Liu, M.; Zhu, M.; He, Q.; Zhang, Q.; Liu, L.; Song, K.; Jia, Q.; Jia, Q.; Li, X.; Tan, J.; Zheng, W.; Wang, R.; Liu, N.; Hu, T. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine (Baltimore), 2016, 95(40)e4573
[http://dx.doi.org/10.1097/MD.0000000000004573] [PMID: 27749526]
[28]
Coban, E.; Yazicioglu, G.; Ozdogan, M. Platelet activation in subjects with subclinical hypothyroidism. Med. Sci. Monit., 2007, 13(4), CR211-CR214.
[PMID: 17392654]
[29]
Atile, N.S.; Bilir, B.E.; Bilir, B.; Guldiken, S. Mean platelet volume levels ın patıents wıth overt hypothyroıdısm before and after levothyroxıne treatment. Acta Endocrinol. (Bucur.), 2012, 8(4), 607-614.
[30]
Erikci, A.A.; Karagoz, B.; Ozturk, A.; Caglayan, S.; Ozisik, G.; Kaygusuz, I.; Ozata, M. The effect of subclinical hypothyroidism on platelet parameters. Hematology, 2009, 14(2), 115-117.
[http://dx.doi.org/10.1179/102453309X385124] [PMID: 19298725]
[31]
Kim, J.H.; Park, J.H.; Kim, S.Y.; Bae, H.Y. The mean platelet volume is positively correlated with serum thyrotropin concentrations in a population of healthy subjects and subjects with unsuspected subclinical hypothyroidism. Thyroid, 2013, 23(1), 31-37.
[http://dx.doi.org/10.1089/thy.2012.0033] [PMID: 22966899]
[32]
Dastjerdi, M.S.; Emami, T.; Najafian, A.; Amini, M. Mean platelet volume measurement, EDTA or citrate? Hematology, 2006, 11(5), 317-319.
[http://dx.doi.org/10.1080/10245330600954163] [PMID: 17607580]
[33]
Roxburgh, C.S.; McMillan, D.C. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol., 2010, 6(1), 149-163.
[http://dx.doi.org/10.2217/fon.09.136] [PMID: 20021215]
[34]
Bayir, O.; Karagoz, T.; Ocal, B.; Cakal, E.; Saylam, G.; Korkmaz, M.H. Predictive role of neutrophil-lymphocyte and platelet-lymphocyte ratios in thyroid nodules with cytological diagnosis of “undetermined significance” and “suspicious for malignancy”. ENT Updates, 2017, 7(1), 28-32.
[http://dx.doi.org/10.2399/jmu.2017001003]
[35]
Kim, S.M.; Kim, E.H.; Kim, B.H.; Kim, J.H.; Park, S.B.; Nam, Y.J.; Ahn, K.H.; Oh, M.Y.; Kim, W.J.; Jeon, Y.K.; Kim, S.S.; Kim, Y.K.; Kim, I.J. Association of the Preoperative Neutrophil-to-ymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer. Endocrinol. Metab. (Seoul), 2015, 30(4), 494-501.
[http://dx.doi.org/10.3803/EnM.2015.30.4.494] [PMID: 26354491]
[36]
Seretis, C.; Gourgiotis, S.; Gemenetzis, G.; Seretis, F.; Lagoudianakis, E.; Dimitrakopoulos, G. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am. J. Surg., 2013, 205(6), 691-696.
[http://dx.doi.org/10.1016/j.amjsurg.2012.08.006] [PMID: 23388425]
[37]
Han, S.W.; Kang, S.Y.; Kim, S.K.; Youn, H.J.; Jung, S.H. Clinical significance of blood neutrophil-to-lymphocyte ratio in patients with papillary thyroid carcinoma. Korean J. Endocr. Surg., 2014, 14, 184-189.
[http://dx.doi.org/10.16956/kjes.2014.14.4.184]
[38]
Keskin, H.; Kaya, Y.; Cadirci, K.; Kucur, C.; Ziypak, E.; Simsek, E.; Gozcu, H.; Arikan, S.; Carlioglu, A. Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyreotidis. Endocr. Regul., 2016, 50(3), 148-153.
[http://dx.doi.org/10.1515/enr-2016-0017] [PMID: 27560798]
[39]
Bhat, T.; Teli, S.; Rijal, J.; Bhat, H.; Raza, M.; Khoueiry, G.; Meghani, M.; Akhtar, M.; Costantino, T. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review. Expert Rev. Cardiovasc. Ther., 2013, 11(1), 55-59.
[http://dx.doi.org/10.1586/erc.12.159] [PMID: 23259445]
[40]
Celikbilek, M.; Dogan, S.; Ozbakır, O.; Zararsız, G.; Kücük, H.; Gürsoy, S.; Yurci, A.; Güven, K.; Yücesoy, M. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J. Clin. Lab. Anal., 2013, 27(1), 72-76.
[http://dx.doi.org/10.1002/jcla.21564] [PMID: 23292894]
[41]
Aksu, O.; Aydın, B.; Koroglu, B.K.; Tamer, M.N. An evaluation of the Neutrophil/Lymphocyte ratio in patients with Hashimoto’s thyroiditis. Acta Med. Mediter., 2014, 30, 457-460.
[42]
Demir, Y.; Üçler, R.; Sürücü, E.; Turan, M.; Balli, Z.; Şengöz, T. Temporary changes in neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios, and mean platelet volume reflecting the inflammatory process after radioiodine therapy. Nucl. Med. Commun., 2016, 37(4), 393-398.
[http://dx.doi.org/10.1097/MNM.0000000000000452] [PMID: 26619396]
[43]
Monzen, S.; Mariya, Y.; Wojcik, A.; Kawamura, C.; Nakamura, A.; Chiba, M.; Hosoda, M.; Takai, Y. Predictive factors of cytotoxic damage in radioactive iodine treatment of differentiated thyroid cancer patients. Mol. Clin. Oncol., 2015, 3(3), 692-698.
[http://dx.doi.org/10.3892/mco.2015.499] [PMID: 26137289]
[44]
Bayhan, Z.; Zeren, S.; Ozbay, I.; Kahraman, C.; Yaylak, F.; Tiryaki, C.; Ekici, M. Mean Platelet Volume as a Biomarker for Thyroid Carcinoma. Int. Surg., 2015, 101, 50-53.
[http://dx.doi.org/10.9738/INTSURG-D-15-00123.1] [PMID: 26160507]
[45]
Dincel, O.; Bayraktar, C. Evaluation of platelet indices as a useful marker in papillary thyroid carcinoma. Bratisl. Lek Listy, 2017, 118(3), 153-155.
[http://dx.doi.org/10.4149/BLL_2017_030] [PMID: 28319410]
[46]
Yaylaci, S.; Tosun, O.; Sahin, O.; Genc, A.B.; Aydin, E.; Demiral, G.; Karahalil, F.; Olt, S.; Ergenc, H.; Varim, C. Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer. Asian Pac. J. Cancer Prev., 2016, 17(4), 2321-2323.
[http://dx.doi.org/10.7314/APJCP.2016.17.4.2321] [PMID: 27221938]
[47]
Atılgan, C.U.; Sendul, S.Y.; Kosekahya, P.; Çaglayan, M.; Alkan, A.; Guven, D.; Yılmazbas, P. The Neutrophil to Lymphocyte Ratio in Patients with Thyroid Orbitopathy. Med Bull Sisli Etfal Hos., 2018, 52(1), 26-30.
[48]
Liu, C.L.; Lee, J.J.; Liu, T.P.; Chang, Y.C.; Hsu, Y.C.; Cheng, S.P. Blood neutrophil-to-lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J. Surg. Oncol., 2013, 107(5), 493-497.
[http://dx.doi.org/10.1002/jso.23270] [PMID: 22996403]
[49]
Kocer, D.; Karakukcu, C.; Karaman, H.; Gokay, F.; Bayram, F. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac. J. Cancer Prev., 2015, 16(9), 3875-3879.
[http://dx.doi.org/10.7314/APJCP.2015.16.9.3875] [PMID: 25987053]
[50]
Gong, W.; Yang, S.; Yang, X.; Guo, F. Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer. Clinics (São Paulo), 2016, 71(6), 311-314.
[http://dx.doi.org/10.6061/clinics/2016(06)04] [PMID: 27438563]
[51]
Liu, J.; Du, J.; Fan, J.; Liu, K.; Zhang, B.; Wang, S.; Wang, W.; Wang, Z.; Cai, Y.; Li, C.; Yu, T.; Zhu, G.; Chen, J.; Li, C. The Neutrophil-to-Lymphocyte Ratio Correlates with Age in Patients with Papillary Thyroid Carcinoma. ORL J. Otorhinolaryngol. Relat. Spec., 2015, 77(2), 109-116.
[http://dx.doi.org/10.1159/000375534] [PMID: 25896501]
[52]
Lang, B.H.; Ng, C.P.; Au, K.B.; Wong, K.P.; Wong, K.K.; Wan, K.Y. Does preoperative neutrophil lymphocyte ratio predict risk of recurrence and occult central nodal metastasis in papillary thyroid carcinoma? World J. Surg., 2014, 38(10), 2605-2612.
[http://dx.doi.org/10.1007/s00268-014-2630-z] [PMID: 24809487]
[53]
Templeton, A.J.; Ace, O.; McNamara, M.G.; Al-Mubarak, M.; Vera-Badillo, F.E.; Hermanns, T.; Seruga, B.; Ocaña, A.; Tannock, I.F.; Amir, E. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol. Biomarkers Prev., 2014, 23(7), 1204-1212.
[http://dx.doi.org/10.1158/1055-9965.EPI-14-0146] [PMID: 24793958]


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VOLUME: 19
ISSUE: 6
Year: 2019
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DOI: 10.2174/1871530319666190206125545
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