Objective: This study addresses the association of hematological inflammatory indices with remission in patients with Graves’ disease (GD) and their potential contribution as remission-related markers.
Materials and
Methods: This retrospective cohort study was conducted at a single tertiary endocrinology center. The study cohort consisted of 78 adults with GD who were admitted to a tertiary endocrinology clinic from September 2022 to September 2023. Demographic, clinical, and laboratory data, including thyroid function tests and thyrotropin receptor antibody (TRAb) levels, were collected. Indices reflecting systemic inflammation, namely, aggregate index of systemic inflammation, systemic inflammation response index, systemic immune-inflammation index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio, were calculated using complete blood count parameters. Remission was defined as achieving clinical and biochemical euthyroidism following 12–18 months of continuous antithyroid drug therapy, maintained without relapse for at least 12 months after treatment discontinuation. Subjects were stratified by remission status, and six separate binary logistic regression models were constructed, each including TRAb, age, and sex as core covariates alongside one inflammatory index, to avoid quasi-complete separation arising from a low events-per-variable ratio.

Results: Remission was achieved in 44.9% of patients. Baseline T3, T4, and TRAb levels were significantly elevated in patients without remission (all p<0.001). Age, sex, and inflammatory indices were comparable between groups (all p>0.05). In all six logistic regression models, TRAb was the only independent predictor of non-remission (Odds ratio: 1.267, 95% confidence interval [CI]: 1.144–1.403, p<0.001 across models), while no inflammatory index achieved statistical significance. Receiver operating characteristic analysis demonstrated excellent discriminatory performance for TRAb (area under the curve=0.897, 95% CI: 0.824–0.971, p<0.001), with a cohort-derived cut-off of 13.6 IU/L (sensitivity 91.4%, specificity 83.7%). This cut-off should be regarded as exploratory because it was derived from a small, single-center cohort without external validation.

Conclusion: TRAb is the most reliable predictor of remission in GD, whereas hematological inflammatory indices do not appear to have significant predictive value. These findings highlight the limited clinical utility of non-specific inflammatory markers and reinforce the importance of disease-specific autoantibodies in determining prognosis.