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High neutrophil-to-lymphocyte ratio is associated with relapse in Graves’ disease after antithyroid drug therapy

  • Mijin Kim
  • Bo Hyun KimEmail author
  • Min Hee Jang
  • Jeong Mi Kim
  • Eun Heui Kim
  • Yun Kyung Jeon
  • Sang Soo Kim
  • In Joo Kim
Original Article



Antithyroid drugs (ATDs) are effective in controlling hyperthyroidism due to Graves’ disease (GD); however, long-term remission rates are low. The neutrophil-to-lymphocyte ratio (NLR) is a useful prognostic marker in many inflammatory diseases. We aimed to evaluate whether NLR can be used as a prognostic marker for relapse in patients with GD after ATD therapy.


This retrospective cohort study included 108 patients with newly diagnosed GD who achieved remission after ATD therapy and were followed-up for >12 months after ATD discontinuation. The primary outcome was relapse-free survival (RFS).


Patients were classified into two groups according to baseline NLR: low NLR group with NLR < 1.14 (n = 59; 55%) and high NLR group with NLR ≥ 1.14 (n = 49; 45%). During the median follow-up of 6.5 years, disease relapse after a year of ATD withdrawal occurred in 23 (21%) patients. The patients with high NLR had poorer RFS than those with low NLR, and RFS curves were significantly different between the two groups (p = 0.002). In multivariate analysis, a high NLR (OR = 4.22, p = 0.016) was an independent prognostic factor for relapse in patients with GD after adjusting for age, sex, goiter, orbitopathy, thyroid hormone levels, thyrotropin binding inhibiting immunoglobulin titer, and the duration of ATD therapy.


This study showed that NLR can be an early and cost-effective prognostic biomarker for relapse in patients with GD after ATD therapy. Further studies are needed to validate the prognostic role of NLR in GD.


Neutrophil Lymphocyte Graves’ disease Antithyroid drug Relapse 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the institutional review board of PNUH, Busan, the Republic of Korea (No. 1906-013-080).

Supplementary material

12020_2019_2137_MOESM1_ESM.docx (162 kb)
Supplementary Information


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Biomedical Research InstitutePusan National University HospitalBusanKorea

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