The Application of Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in the Prognostic Assessment of Graves' Disease

Objective To investigate the clinical determinants of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and evaluate their prognostic significance in Graves' disease (GD) progression. Methods We conducted a retrospective cohort study of 148 treatment-naïve GD patients and 112 age-/sex-matched healthy controls from January 2023 to January 2024.Comprehensive parameters including blood indices (NLR, PLR), thyroid function profiles (FT3, FT4, TSH, TPOAb, TGAb, TRAb), and ultrasonographic thyroid volume measurements were analyzed.Multivariate linear regression models were employed to identify independent predictors of NLR, PLR, and thyroid volume. Time-to-event analysis using Kaplan-Meier curves with log-rank tests assessed treatment response duration. Results GD patients exhibited significantly elevated NLR (1.52 [IQR 1.15–2.15] vs 0.02 [0.01–0.02], P < 0.001) and PLR (117.39 [95.16-150.15] vs 0.19 [0.18–0.27], P < 0.001) versus controls. Regression analysis revealed NLR positively correlated with age (B = 0.015, P = 0.003) but inversely with FT3 (B=-0.011, P = 0.016) and FT4 (B=-0.010, P = 0.006). PLR showed inverse association with FT4 (B=-0.660, P = 0.013). Thyroid volume positively correlated with FT3 (B = 247.707, P < 0.001), TPOAb (B = 11.165, P < 0.001), and TRAb (B = 211.283, P = 0.012), while negatively with age (B=-115.189, P = 0.015) and female sex (B=-7003.903, P < 0.001).Kaplan-Meier analysis demonstrated significantly prolonged median time to euthyroidism in high-NLR (≥ 0.87) versus low-NLR patients (405 vs 277 days, P < 0.05), whereas high-PLR (≥ 109) patients achieved normalization faster than low-PLR counterparts (318 vs 391 mean days, P < 0.05). Conclusions As potential prognostic biomarkers in GD patients,the level of NLR and PLR is inversely proportional to thyroid hormone levels.Elevated NLR predicts delayed treatment response, while higher PLR associates with faster thyroid function recovery. These findings provide new references for the prognostic assessment of GD patients.