Endocrinology & Metabolic Syndrome
Open Access
ISSN: 2161-1017
ISSN: 2161-1017
Dr. Manash P Baruah
Apollo Excel care Hospital, India
Scientific Tracks Abstracts: Endocrinol Metab Syndr
C- reactive protein (CRP), which is a marker of inflammation, has not been widely studied in inflammatory thyroid disorders particularly in sub-acute thyroiditis (SAT). Its usage remains largely subjective. CRP and erythrocyte sedimentation rate (ESR) are useful indicators of inflammation in patients with SAT. We tried to compare the scope of utilising CRP and ESR objectively in thyrtoxicosis, more particularly in thyroiditis. Firstly, we used both CRP and ESR to differentiate inflammatory thyroiditis from Graves’ disease , another common cause of thyrotoxicosis. Serum CRP level was high in 61% of SAT patients but in none of the Graves′ patients. Mean (SEM) (90%CI) serum CRP level (mg/L) was also significantly higher (P <0.0004) in the SAT group [27.55 (5.76) (15.72-39.38)], than in the Graves’ group [4.09 (0.12) (3.81-4.36)]. The sensitivity of serum CRP was 73.33%, specificity 53.85%, positive predictive value (PPV) 64.71%, and negative predictive value (NPV) 63.64% as compared to the sensitivity (53.57%), specificity (15.38%), PPV (57.69 %), and NPV (13.33%) of ESR. Secondly we tried to compare the scope for utilising CRP and ESR objectively in deciding the requirement of glucocorticoid therapy. The mean CRP value was significantly higher in patients requiring glucocorticoids. The ROC curves indicated that the optimal positivity criterion was 19.3 mg/L for the CRP level and 46 mm at the 1st hour for ESR. CRP with a sensitivity of 0.67, a specificity of 0.92, a positive likelihood ratio of 8.67, and an accuracy of 0.64 appeared better than ESR, which showed a sensitivity of 0.93, a specificity of 0.53, a positive likelihood ratio of 2.02, and an accuracy of 0.60. In conclusion, there is significantly higher rise in serum CRP level in patients with SAT is compared to patients with Graves’ disease. It correlates well with the rise in ESR. Such findings of this pilot study highlight the scope of using serum CRP as a diagnostic marker of SAT specially in situations when it may be confused with Graves’ disease, another common cause of thyrotoxicosis. In addition, serum CRP level provided a clear advantage over ESR in the assessment of the severity of inflammation before initiation of glucocorticoid therapy in SAT.
Dr Manash P Baruah, MBBS, MD, DM, FACE is currently Director, Head of the Department and Consultant in Endocrinology at the Apollo Excelcare Hospital in Guwahati, Assam, India. His research interests are clinical diabetology and metabolic disorders and thyroidology. He has >200 publications (originals, reviews, editorials, conference abstracts and book chapters), with >6,800 citations with H- index of 23 and research interest score of >3500 to his credit. He had served in the research and scientific advisory committees of Endocrine Society of India(ESI) and Research Society of Study of Diabetes in India(RSSDI). He had served as Editor in chief of Journal of Medical Nutrition and Nutraceuticals, and associate editor of Indian Journal of Endocrinology and Metabolism and Thyroid Research and Practice.