J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 6, June 2019, pages 452-457

Clinical, Biochemical, Hematological, Endocrinological and Immunological Differences Between Graves’ Disease Patients With and Without Thyroid Storm

**Table 1.** Clinical Differences Between Graves’ Disease Patients With and Without TS
	Graves’ disease without TS	Graves’ disease with TS	P value
Values except for sex indicate mean ± SD. TS: thyroid storm.
Age (years)	69	49.0 ± 18.0	5	38.4 ± 8.3	0.042
Sex (female, n (%))	69	55 (79.7%)	5	3 (60%)	< 0.001
Body temperature (°C)	35	36.7 ± 0.4	5	38.5 ± 0.9	0.012
Pulse rate (beats/min)	49	102.7 ± 17.6	5	143.0 ± 27.7	0.03

Table 1. Clinical Differences Between Graves’ Disease Patients With and Without TS

Graves’ disease without TS

Graves’ disease with TS

P value

Value

Values except for sex indicate mean ± SD. TS: thyroid storm.

Age (years)

49.0 ± 18.0

38.4 ± 8.3

0.042

Sex (female, n (%))

55 (79.7%)

3 (60%)

< 0.001

Body temperature (°C)

36.7 ± 0.4

38.5 ± 0.9

0.012

Pulse rate (beats/min)

102.7 ± 17.6

143.0 ± 27.7

0.03

**Table 2.** Differences in TSH, Thyroid Hormones and Thyroid Autoantibodies Between Graves’ Disease Patients With and Without TS
	Graves’ disease without TS	Graves’ disease with TS	P value
Values indicate mean ± SD. TS: thyroid storm; Tg-Ab: thyroglobulin antibody; TPO-Ab: thyroid peroxidase antibody; TSH: thyroid-stimulating hormone; T3: triiodothyronine; T4: thyroxine; TRAb: TSH receptor antibody.
TSH (µIU/mL)	69	0.03 ± 0.01	5	0.03 ± 0.00	0.253
Free T3 (pg/mL)	61	14.0 ± 8.0	5	24.1 ± 6.0	0.016
Free T4 (µg/dL)	69	3.7 ± 1.9	5	7.1 ± 1.8	0.011
Free T3/Free T4	61	3.6 ±0.7	5	3.4 ± 0.5	0.481
Third-generation TRAb (IU/L)	37	16.2 ±11.9	5	30.0 ± 0.00	< 0.001
TPO-Ab (IU/mL)	53	151.6 ± 199.2	4	464.0 ± 272.0	0.103
Tg-Ab (IU/mL)	51	207.4 ± 257.3	3	1,863.0 ± 1,688.8	0.231

Table 2. Differences in TSH, Thyroid Hormones and Thyroid Autoantibodies Between Graves’ Disease Patients With and Without TS

Graves’ disease without TS

Graves’ disease with TS

P value

Values

Values indicate mean ± SD. TS: thyroid storm; Tg-Ab: thyroglobulin antibody; TPO-Ab: thyroid peroxidase antibody; TSH: thyroid-stimulating hormone; T3: triiodothyronine; T4: thyroxine; TRAb: TSH receptor antibody.

TSH (µIU/mL)

0.03 ± 0.01

0.03 ± 0.00

0.253

Free T3 (pg/mL)

14.0 ± 8.0

24.1 ± 6.0

0.016

Free T4 (µg/dL)

3.7 ± 1.9

7.1 ± 1.8

0.011

Free T3/Free T4

3.6 ±0.7

3.4 ± 0.5

0.481

Third-generation TRAb (IU/L)

16.2 ±11.9

30.0 ± 0.00

< 0.001

TPO-Ab (IU/mL)

151.6 ± 199.2

464.0 ± 272.0

0.103

Tg-Ab (IU/mL)

207.4 ± 257.3

1,863.0 ± 1,688.8

0.231

**Table 3.** Differences in White Blood Cell Fractions Between Graves’ Disease Patients With and Without TS
	Graves’ disease without TS	Graves’ disease with TS	P value
Values indicate mean ± SD. TS: thyroid storm.
White blood cells (/mL)	66	5,527.3 ± 1,780.4	5	7,480.0 ± 5622.5	0.482
Neutrophils (%)	56	52.6 ± 12.6	5	77.9 ± 11.2	0.005
Lymphocytes (%)	56	36.7 ± 10.8	5	16.1 ± 10.5	0.009
Monocytes (%)	56	7.7 ± 2.5	5	5.3 ± 1.9	0.044
Eosinophils (%)	56	2.9 ± 2.6	5	0.2 ± 0.5	< 0.001

Table 3. Differences in White Blood Cell Fractions Between Graves’ Disease Patients With and Without TS

Graves’ disease without TS

Graves’ disease with TS

P value

Value

Values indicate mean ± SD. TS: thyroid storm.

White blood cells (/mL)

5,527.3 ± 1,780.4

7,480.0 ± 5622.5

0.482

Neutrophils (%)

52.6 ± 12.6

77.9 ± 11.2

0.005

Lymphocytes (%)

36.7 ± 10.8

16.1 ± 10.5

0.009

Monocytes (%)

7.7 ± 2.5

5.3 ± 1.9

0.044

Eosinophils (%)

2.9 ± 2.6

0.2 ± 0.5

< 0.001

**Table 4.** Biochemical Differences Between Graves’ Disease Patients With and Without TS
	Graves’ disease without TS	Graves’ disease with TS	P value
Values indicate mean ± SD. TS: thyroid storm.
Albumin (g/dL)	61	4.1 ± 0.5	5	3.3 ± 0.8	0.108
Aspartate transaminase (U/L)	69	27.3 ± 16.5	5	34.8 ± 6.5	0.065
Alanine aminotransferase (U/L)	69	34.6 ± 28.0	5	26.2 ± 7.0	0.084
Alkaline phosphatase (U/L)	57	367.2 ± 154.6	5	515.2 ± 107.6	0.033
Gamma-glutamyl transpeptidase (U/L)	57	36.8 ± 34.5	5	48.2 ± 28.2	0.432
Creatine kinase (U/L)	55	66.4 ± 50.2	4	80.8 ± 61.4	0.676
Total bilirubin (mg/dL)	52	0.7 ± 0.5	5	3.0 ± 2.3	0.085
Triglyceride (mg/dL)	49	105.0 ± 57.0	3	42.0 ± 18.5	0.006
High-density lipoprotein cholesterol (mg/dL)	43	52.9 ± 10.8	3	29.3 ± 9.3	0.038
Low-density lipoprotein cholesterol (mg/dL)	47	83.3 ± 27.7	4	44.3 ± 10.8	0.001
Blood urea nitrogen (mg/dL)	69	14.9 ± 5.0	5	11.8 ± 4.1	0.176
Creatinine (mg/dL)	69	0.5 ± 0.2	5	0.4 ± 0.1	0.085
Uric acid (mg/dL)	53	5.3 ± 1.5	4	5.9 ± 1.2	0.397
Plasma glucose (mg/dL)	58	114.7 ± 26.9	5	101.8 ± 31.6	0.421
B-type natriuretic peptide (pg/mL)	28	87.4 ± 109.8	4	243.4 ± 346.4	0.435
C-reactive protein (mg/dL)	52	0.2 ± 0.4	4	2.2 ± 2.3	0.183

Table 4. Biochemical Differences Between Graves’ Disease Patients With and Without TS

Graves’ disease without TS

Graves’ disease with TS

P value

Values

Values indicate mean ± SD. TS: thyroid storm.

Albumin (g/dL)

4.1 ± 0.5

3.3 ± 0.8

0.108

Aspartate transaminase (U/L)

27.3 ± 16.5

34.8 ± 6.5

0.065

Alanine aminotransferase (U/L)

34.6 ± 28.0

26.2 ± 7.0

0.084

Alkaline phosphatase (U/L)

367.2 ± 154.6

515.2 ± 107.6

0.033

Gamma-glutamyl transpeptidase (U/L)

36.8 ± 34.5

48.2 ± 28.2

0.432

Creatine kinase (U/L)

66.4 ± 50.2

80.8 ± 61.4

0.676

Total bilirubin (mg/dL)

0.7 ± 0.5

3.0 ± 2.3

0.085

Triglyceride (mg/dL)

105.0 ± 57.0

42.0 ± 18.5

0.006

High-density lipoprotein cholesterol (mg/dL)

52.9 ± 10.8

29.3 ± 9.3

0.038

Low-density lipoprotein cholesterol (mg/dL)

83.3 ± 27.7

44.3 ± 10.8

0.001

Blood urea nitrogen (mg/dL)

14.9 ± 5.0

11.8 ± 4.1

0.176

Creatinine (mg/dL)

0.5 ± 0.2

0.4 ± 0.1

0.085

Uric acid (mg/dL)

5.3 ± 1.5

5.9 ± 1.2

0.397

Plasma glucose (mg/dL)

114.7 ± 26.9

101.8 ± 31.6

0.421

B-type natriuretic peptide (pg/mL)

87.4 ± 109.8

243.4 ± 346.4

0.435

C-reactive protein (mg/dL)

0.2 ± 0.4

2.2 ± 2.3

0.183

**Table 5.** Characteristics for Graves’ Disease Patients With Thyroid Storm Compared to Those Without Thyroid Storm
^aCutoff values were obtained by a receiver operating characteristics (ROC) curve with area under the curve (AUC) > 0.7.
Endocrinological characteristics
Higher free T3 (> 19 pg/mL)^a
Higher free T4 (> 6 mg/dL)^a
Hematological characteristics
Neutrophilia (> 74%)^a
Lymphocytopenia
Monocytopenia
Eosinopenia
Biochemical characteristics
Higher alkaline phosphatase (> 475 U/L)^a
Lower triglyceride
Lower LDL-cholesterol
Lower HDL-cholesterol
Immunological characteristics
Higher titer of the third-generation TSH receptor antibody (> 30 IU/L)

Table 5. Characteristics for Graves’ Disease Patients With Thyroid Storm Compared to Those Without Thyroid Storm

^aCutoff values were obtained by a receiver operating characteristics (ROC) curve with area under the curve (AUC) > 0.7.

Endocrinological characteristics

Higher free T3 (> 19 pg/mL)^a

Higher free T4 (> 6 mg/dL)^a

Hematological characteristics

Neutrophilia (> 74%)^a

Lymphocytopenia

Monocytopenia

Eosinopenia

Biochemical characteristics

Higher alkaline phosphatase (> 475 U/L)^a

Lower triglyceride

Lower LDL-cholesterol

Lower HDL-cholesterol

Immunological characteristics

Higher titer of the third-generation TSH receptor antibody (> 30 IU/L)