Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Albumin/Globulin Oranının Graves Hastalığı ile Subakut Tiroidit Ayırıcı Tanısındaki Yeri: Retrospektif Gözlemsel Bir Çalışma
The Role of Albumin/Globulin Ratio in the Differential Diagnosis of Subacute Thyroiditis with Graves' Disease: A Retrospective Observational Study
Mehmet ŞİMŞEKa , Mehmet GÜVENa , Hikmet SOYLUa , Başak BOLAYIRa , Dilek GENEŞa , Sedat ÇETİNa , Halit DİRİa , Nurettin AYb
aSağlık Bilimleri Üniversitesi Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Endokrinoloji ve Metabolizma Hastalıkları BD, Diyarbakır, Türkiye
bSağlık Bilimleri Üniversitesi Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Genel Cerrahi AD, Diyarbakır, Türkiye
Turkiye Klinikleri J Intern Med. 2023;8(3):73-8
doi: 10.5336/intermed.2024-103604
Article Language: TR
Full Text
ÖZET
 Amaç: Graves hastalığı ve subakut tiroidit, tirotoksikozun farklı iki nedenidir. Klinik pratikte bu iki hastalığı ayırt etmek her zaman kolay olamamaktadır. Albumin ve globulinler, sistemik inflamatuar sürece katılan iki majör serum protein komponentidir. Son zamanlarda yapılan çalışmalarda, albumin/globulin oranının (AGO) birçok hastalık için yeni bir prognostik belirteç olarak kullanılabileceği kabul görmeye başlanmıştır. Çalışmamızda yeni tanı subakut tiroidit ile Graves hastalığını hızlı ve pratik bir şekilde ayırt etmede AGO'nun prediktif değerini araştırmayı amaçladık. Gereç ve Yöntemler: Endokrinoloji polikliniklerine 1 Ocak 2020-31 Aralık 2022 tarihlerinde başvurup yeni tanı tirotoksikozu olan hastaların, elektronik hastane bilgi sisteminden retrospektif olarak hemogram, tiroid stimülan hormon (TSH), serbest T4, serbest T3, albumin, globulin, eritrosit sedimentasyon hızı [erythrocyte sedimentation rate (ESR)], C-reaktif protein (CRP), TSH reseptör antikor (TRAb) ve tiroid ultrasonografi sonuçlarına bakılarak iki gruba ayrıldı. Subakut tiroidit tanısı konulan hastalar Grup 1 (n=69) ve Graves hastalığı tanısı konulanlar Grup 2 (n=75) olarak adlandırıldı. Daha sonra tanı anında bakılan albumin ve globulin düzeylerine göre AGO hesaplanarak her iki grup karşılaştırıldı. Bulgular: Her iki grupta tiroid hormon düzeyleri açısından anlamlı farklılık izlenmedi (p>0,05). Beyaz küre sayısı, CRP ve ESR Grup 1'de anlamlı olarak yüksek izlendi (p<0,001). AGO gruplar arasında karşılaştırıldığında Grup 2'de Grup 1'e göre anlamlı olarak yüksek izlendi (sırasıyla 1,35, 0,88; p<0,001). AGO, ESR ve CRP düzeyi ile negatif yönde korelasyon gösterdi (sırasıyla p<0,001, p<0,001). Subakut tiroidit ile Graves hastalığı ayırıcı tanısında AGO eşik değeri 1,11 olarak bulundu (sensitivitesi %96, spesifitesi %98). Sonuç: AGO, Graves hastalığı ile subakut tiroidit ayrımını sağlamada kullanılabilecek alternatif yeni bir hematolojik parametre olabilir.

Anahtar Kelimeler: Graves hastalığı; subakut tiroidit; albumin/globulin oranı
ABSTRACT
 Objective: Graves' disease and subacute thyroiditis are two different causes of thyrotoxicosis. In clinical practice, it is not always easy to distinguish between these two diseases. Albumin and globulins are two major serum protein components involved in the systemic inflammatory process. In recent studies, it has begun to be accepted that the albumin/globulin ratio (AGR) can be used as a new prognostic marker for many diseases. In our study, we aimed to investigate the predictive value of AGR in quickly and practically distinguishing between newly diagnosed subacute thyroiditis and Graves' disease. Material and Methods: January 1, 2020 to December 31, 2022, patients with newly diagnosed thyrotoxicosis who applied to endocrinology outpatient clinics were divided into two groups by retrospectively looking at hemogram, thyroid stimulating hormone (TSH), free T4, free T3, albumin, globulin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), TSH receptor antibody (TRAb) and thyroid ultrasonography results from the electronic hospital information system. Patients diagnosed with subacute thyroiditis were called Group 1 (n=69) and those diagnosed with Graves' disease were called Group 2 (n=75). Then, AGR was calculated according to the albumin and globulin levels examined at the time of diagnosis and both groups were compared. Results: There was no significant difference in thyroid hormone levels in both groups (p>0.05). White blood cell count, CRP and ESR were significantly higher in Group 1 (p<0.001). When AGO was compared between groups, it was significantly higher in Group 2 than in Group 1 (1.35, 0.88, respectively; p<0.001). AGR was negatively correlated with sedimentation and CRP level (p<0.001, p<0.001, respectively). The AGR threshold value in the differential diagnosis of subacute thyroiditis and Graves' disease was found to be 1.11 (sensitivity 96%, specificity 98%). Conclusion: The AGR may be an alternative new hematological parameter that can be used to distinguish between Graves' disease and subacute thyroiditis.

Keywords: Graves disease; subacute thyroiditis; albumin/globulin ratio
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