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      Mean Platelet Volume in Graves’ disease: A Sign of Hypermetabolism Rather than Autoimmunity?

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          Abstract

          Objective:

          To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves’ disease (GD).

          Methods:

          This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants.

          Results:

          The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0±1.2 fL in the Relapse group vs. 8.0±1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2±1.3 fL) than it was in the Remission group (8.0±1.2 fL, p=0.00).

          Conclusions:

          Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD.

          Abbreviations:

          BMI: Body mass index

          GD: Graves’ disease

          MPV: Mean platelet volume

          TSH: Thyroid-stimulating hormone

          TRAbs: Thyrotropin receptor antibodies

          ATD: Anti-thyroid drug

          fT4: Free thyroxine

          fT3: Free triiodothyronine

          CBC: Complete blood count

          PTC: Papillary thyroid carcinoma

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          Most cited references21

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          Antithyroid drugs.

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            Clinical practice. Graves' disease.

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              Current perspective on the pathogenesis of Graves' disease and ophthalmopathy.

              Graves' disease (GD) is a very common autoimmune disorder of the thyroid in which stimulatory antibodies bind to the thyrotropin receptor and activate glandular function, resulting in hyperthyroidism. In addition, some patients with GD develop localized manifestations including ophthalmopathy (GO) and dermopathy. Since the cloning of the receptor cDNA, significant progress has been made in understanding the structure-function relationship of the receptor, which has been discussed in a number of earlier reviews. In this paper, we have focused our discussion on studies related to the molecular mechanisms of the disease pathogenesis and the development of animal models for GD. It has become apparent that multiple factors contribute to the etiology of GD, including host genetic as well as environmental factors. Studies in experimental animals indicate that GD is a slowly progressing disease that involves activation and recruitment of thyrotropin receptor-specific T and B cells. This activation eventually results in the production of stimulatory antibodies that can cause hyperthyroidism. Similarly, significant new insights have been gained in our understanding of GO that occurs in a subset of patients with GD. As in GD, both environmental and genetic factors play important roles in the development of GO. Although a number of putative ocular autoantigens have been identified, their role in the pathogenesis of GO awaits confirmation. Extensive analyses of orbital tissues obtained from patients with GO have provided a clearer understanding of the roles of T and B cells, cytokines and chemokines, and various ocular tissues including ocular muscles and fibroblasts. Equally impressive is the progress made in understanding why connective tissues of the orbit and the skin in GO are singled out for activation and undergo extensive remodeling. Results to date indicate that fibroblasts can act as sentinel cells and initiate lymphocyte recruitment and tissue remodeling. Moreover, these fibroblasts can be readily activated by Ig in the sera of patients with GD, suggesting a central role for them in the pathogenesis. Collectively, recent studies have led to a better understanding of the pathogenesis of GD and GO and have opened up potential new avenues for developing novel treatments for GD and GO.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Jul-Aug 2017
                : 33
                : 4
                : 871-875
                Affiliations
                [1 ]Gulay Simsek Bagir, MD. Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
                [2 ]Filiz Eksi Haydardedeoglu, MD. Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
                [3 ]Okan Sefa Bakiner, Associate Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
                [4 ]Emre Bozkirli, Associate Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
                [5 ]Melek Eda Ertorer, Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
                Author notes
                Correspondence: Gulay Simsek Bagir, MD Baskent University School of Medicine, Adana Medical Center, Division of Endocrinology and Metabolism Dadaloglu mah. Serin Evler 39. sok. No: 6 01250, Yuregir / Adana / Turkey. E-mail: gulaysimsekbagir@ 123456yahoo.com
                Article
                PJMS-33-871
                10.12669/pjms.334.12659
                5648955
                8f99bf8a-650c-42d6-8aae-2b213c0d9ba0
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 March 2017
                : 29 June 2017
                : 05 July 2017
                Categories
                Original Article

                autoimmunity,graves’,disease,mean platelet volume
                autoimmunity, graves’, disease, mean platelet volume

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