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Angelopoulos N, Goulis DG, Chrisogonidis I, Livadas S, Iakovou I. Color Doppler ultrasound and real-time elastography in patients with hypothyroidism for the prediction of levothyroxine replacement: a cross-sectional study of 338 patients. J Ultrasound 2024:10.1007/s40477-024-00876-x. [PMID: 38393451 DOI: 10.1007/s40477-024-00876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
AIMS While hormonal assays are commonly used for thyroid function assessment, Doppler sonography provides valuable information on vascularization and blood flow. This study aimed to examine the potential associations between Doppler parameters and clinical characteristics of hypothyroid patients, such as the autoimmune nature of the disease and adequacy of LT4 replacement. METHODS A total of 338 patients with hypothyroidism, primarily caused by autoimmune thyroiditis (AT), were enrolled in this study. Exclusion criteria comprised specific medical conditions, medication history, and nodular abnormalities of the thyroid gland. Patient demographics (age, sex, BMI), treatment parameters (LT4 daily dose), and thyroid hormone levels (TSH, fT4) were recorded. RESULTS Among the enrolled patients, 85.2% had autoimmune thyroiditis. Suboptimal levothyroxine (LT4) replacement was observed in 20.1% of patients at the time of enrollment. Patients with autoimmune thyroiditis had increased elastography ratios compared to those without autoimmune disease and present a positive association of elastography ratios with vascularity. In patients without autoimmune thyroiditis, those with suboptimal LT4 replacement had lower total thyroid volume. Patients with suboptimal LT4 replacement had higher peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the inferior thyroid artery and lower resistive index (RI). The severity of hypothyroidism, as indicated by LT4 dose/body mass index (BMI), was negatively correlated with thyroid volume and EDV values of superior and inferior thyroid arteries. PSV of the inferior thyroid artery can predict suboptimal LT4 replacement (sensitivity 81.8%, specificity 42%). CONCLUSIONS In situations where obtaining blood tests may be challenging, utilizing color Doppler ultrasound can serve as an alternative method to assess treatment responses and identify patients who require further hormonal examinations.
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Affiliation(s)
- Nikolaos Angelopoulos
- 2nd Academic Department of Nuclear Medicine, Faculty of Medicine, School of Health Sciences, AHEPA University Hospital, Venizelou 26, Kavala, 65403, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Chrisogonidis
- Department of Radiology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Iakovou
- 2nd Academic Department of Nuclear Medicine, Faculty of Medicine, School of Health Sciences, AHEPA University Hospital, Venizelou 26, Kavala, 65403, Thessaloniki, Greece
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Guo M, Li Q, Liu X, Wang Y, Yang Q, Li R, Zhao Y, Li C, Sheng S, Ma H, Li Z, Gao R. Mapping the path towards novel treatment strategies: a bibliometric analysis of Hashimoto's thyroiditis research from 1990 to 2023. Front Endocrinol (Lausanne) 2023; 14:1277739. [PMID: 38027117 PMCID: PMC10667915 DOI: 10.3389/fendo.2023.1277739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hashimoto's thyroiditis (HT), a common form of thyroid autoimmunity, is strongly associated with deteriorating clinical status and impaired quality of life. The escalating global prevalence, coupled with the complexity of disease mechanisms, necessitates a comprehensive, bibliometric analysis to elucidate the trajectory, hotspots, and future trends in HT research. Objective This study aims to illuminate the development, hotspots, and future directions in HT research through systematic analysis of publications, institutions, authors, journals, references, and keywords. Particular emphasis is placed on novel treatment strategies for HT and its complications, highlighting the potential role of genetic profiling and immunomodulatory therapies. Methods We retrieved 8,726 relevant documents from the Web of Science Core Collection database spanning from 1 January 1990 to 7 March 2023. Following the selection of document type, 7,624 articles were included for bibliometric analysis using CiteSpace, VOSviewer, and R software. Results The temporal evolution of HT research is categorized into three distinct phases: exploration (1990-1999), rapid development (1999-2000), and steady growth (2000-present). Notably, the United States, China, Italy, and Japan collectively contributed over half (54.77%) of global publications. Among the top 10 research institutions, four were from Italy (4/10), followed by China (2/10) and the United States (2/10). Recent hotspots, such as the roles of gut microbiota, genetic profiling, and nutritional factors in HT management, the diagnostic dilemmas between HT and Grave's disease, as well as the challenges in managing HT complicated by papillary thyroid carcinoma and type 1 diabetes mellitus, are discussed. Conclusion Although North America and Europe have a considerable academic impact, institutions from emerging countries like China are demonstrating promising potential in HT research. Future studies are anticipated to delve deeper into the differential diagnosis of HT and Grave's disease, the intricate relationship between gut microbiota and HT pathogenesis, clinical management of HT with papillary thyroid carcinoma or type 1 diabetes, and the beneficial effects of dietary modifications and micronutrients supplementation in HT. Furthermore, the advent of genetic profiling and advanced immunotherapies for managing HT offers promising avenues for future research.
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Affiliation(s)
- Manping Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Postdoctoral Research Station, China Academy of Chinese Medical Sciences, Beijing, China
- Postdoctoral Works Station, Yabao Pharmaceutical Group Co., Ltd., Yuncheng, Shanxi, China
| | - Qingna Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Xingfang Liu
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Yiming Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiaoning Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Rui Li
- Evidence Based Medicine Center, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Yang Zhao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Chenfei Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Song Sheng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hangkun Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhenghong Li
- Research Department, Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
| | - Rui Gao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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Assem Hussein M, Abdel Hamid A, M Abdel Samie R, Hussein E, Sadik Elsawy S. Duplex Hemodynamic Parameters of Both Superior and Inferior Thyroid Arteries in Evaluation of Thyroid Hyperfunction Disorders. Int J Gen Med 2022; 15:7131-7144. [PMID: 36110917 PMCID: PMC9470082 DOI: 10.2147/ijgm.s375016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022] Open
Abstract
Background Thyrotoxicosis may be caused by Graves’ disease or destructive thyroiditis. Differentiation between causes of thyrotoxicosis is crucial as management will differ. 99mTechnetium (Tc)-pertechnetate thyroid scintigraphy is currently the gold standard for this purpose, however, is expensive and uses ionizing radiation. Objective To evaluate the role of color flow Doppler Ultrasound (CDU) of the superior thyroid (STA) and inferior thyroid arteries (ITA) as an inexpensive, non-invasive tool that can aid in differentiating between Graves’ disease and thyroiditis and compare it with thyroid scintigraphy. Methods Sixty-nine patients with newly-diagnosed thyrotoxicosis and 30 controls were enrolled. Thyroid functions, thyroid scintigraphy, and CDU of STA and ITA with measurements of peak systolic velocity (PSV) and end diastolic velocity (EDV), were performed. According to thyroid scintigraphy results, patients were divided into two groups: 42 patients with Graves’ disease and 27 patients with thyroiditis. Results PSV and EDV of both STA and ITA were significantly higher in patients with Graves’ disease than thyroiditis (p-values <0.001). The STA-PSV had an equal sensitivity and specificity of 66.7%; cut-off value 76.57 cm/s, while those of STA-EDV were 73.8%, and 77.8% respectively; cut-off value 28.22 cm/s. ITA-PSV had a sensitivity and specificity of 76.2% and 77.8%, respectively; cut-off value 62.12 cm/s), while those of ITA-EDV were 78.6% and 77.8%, respectively; cut-off value 5.22 cm/s. Conclusion CDU parameters of the STA and ITA could be used as an alternative to thyroid scintigraphy for discriminating between Graves’ disease and thyroiditis.
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Affiliation(s)
- Maha Assem Hussein
- Internal Medicine Department, Faculty of Medicine, Kasr El-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Alaa Abdel Hamid
- Kasr El-Ainy Vascular Laboratory, Cairo University, Cairo, Egypt
| | - Rasha M Abdel Samie
- Internal Medicine Department, Faculty of Medicine, Kasr El-Ainy Hospital, Cairo University, Cairo, Egypt
- Correspondence: Rasha M Abdel Samie, Email
| | - Elshaymaa Hussein
- Nuclear Medicine Department, Faculty of Medicine, Kasr El-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Shereen Sadik Elsawy
- Internal Medicine Department, Faculty of Medicine, Kasr El-Ainy Hospital, Cairo University, Cairo, Egypt
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Li L, Zhang A, Chen D, Taragin BH, Luo X. Preliminary study of sound touch elastography in diffuse thyroid disease in children. Front Pediatr 2022; 10:964413. [PMID: 36275048 PMCID: PMC9582431 DOI: 10.3389/fped.2022.964413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of sound touch elastography (STE) in conjunction with conventional ultrasound in the differential diagnosis of diffuse thyroid disease (DTD) and normal thyroid in children. METHODS Studies performed on 62 children with DTD and 30 normal volunteers were reviewed. Standard gray scale ultrasound, Doppler ultrasound and STE of the examinees, and the serum test results of children with DTD were collected, analyzed and compared. RESULTS The STE-Mean values in the Graves' disease (GD) group, Hashimoto's thyroiditis (HT) group, and normal control group, respectively, were 19.35 ± 5.00 kPa, 19.43 ± 6.06 kPa, and 11.24 ± 1.99 kPa. With an area under the ROC curve (AUC) of 0.945, STE-Mean values differentiated DTD from normal children. The peak systolic velocity (PSV) of the superior thyroid artery separated DTD from normal children and AUC from children with GD and HT, respectively, and was 0.992 and 0.864. The PSV of superior thyroid artery revealed a somewhat favorable connection with FT3 and FT4. CONCLUSION The STE results revealed that thyroid stiffness was higher in children with DTD than in normal children, but further differentiation into GD and HT subgroups lacked specificity, and the superior thyroid artery flow velocity might be a good supplement to distinguish both.
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Affiliation(s)
- Lin Li
- Department of Ultrasonography, Suining Central Hospital, Suining, China
| | - Aimei Zhang
- Department of Ultrasonography, Suining Central Hospital, Suining, China
| | - Dan Chen
- Department of Ultrasonography, Suining Central Hospital, Suining, China
| | - Benjamin H Taragin
- Department of Radiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Xiaoyong Luo
- Department of Ultrasonography, Suining Central Hospital, Suining, China
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Zhang L, Li J, Zhang S, Su C, Su Z, Zhang Y, Gai Y, Shao S, Li J, Zhang G. Study of the Associations between Color Doppler Ultrasound Grading of Hyperthyroidism and Biochemical Data on Thyroid Function. Int J Endocrinol 2022; 2022:9743654. [PMID: 35942151 PMCID: PMC9356896 DOI: 10.1155/2022/9743654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The main study objective was to investigate the correlation between the color Doppler ultrasound grading of hyperthyroidism and the biochemical data of thyroid function. METHODS Seventy-six patients were diagnosed with hyperthyroidism based on clinical and laboratory data at our hospital. The patients were examined using color Doppler ultrasound and laboratory investigations before starting 131I treatment. First, patients were divided into two groups based on the blood flow distribution determined by ultrasound. If the blood flow signal in the parenchyma was scattered and thinned, with dispersive points and discontinuous streaky distribution, the blood flow distribution area in the sample frame was less than or equal to 1/2 of the sample frame area and was judged to be level 1. If the parenchyma was filled with diffuse blood flow signals or if most areas had depicted rich blood flow distribution when the area of blood flow distribution in the sampling frame was greater than 1/2 of the sampling frame area, it was judged to be level 2. Then, the correlations between color Doppler ultrasound grading and biochemical data of thyroid function were analyzed. The indices included FT3, FT4, TSH, anti-TG, anti-TPO, and TRAb. Parameters of thyroid homeostasis, including thyroid's secretory capacity (SPINA-GT), the total deiodinase activity (SPINA-GD), Jostel's TSH index, and the thyrotroph thyroid hormone sensitivity index (TTSI), were calculated and compared. RESULTS Correlations were noted between color Doppler ultrasound grading and FT3, FT4, TRAb, SPINA-GT, TSHI, and TTSI. Moreover, FT3, FT4, TRAb, SPINA-GT, TSHI, and TTSI were higher in level 2 patients compared with level 1 patients. CONCLUSION Correlations were noted between color Doppler ultrasound grading and biochemical data of thyroid function.
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Affiliation(s)
- Lingyun Zhang
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Jie Li
- Department of Outpatient, Outpatient of Jinan Municipal People's Government, Jinan, China
| | - Suzhen Zhang
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Chen Su
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Zengcun Su
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Yuezhong Zhang
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Yonghao Gai
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Shanshan Shao
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, China
| | - Jianzhi Li
- Department of Ultrasonography, Shandong Public Health Clinical Center, Jinan, China
| | - Guoquan Zhang
- Department of Ultrasonography, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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Andaç Baltacıoğlu N, Mantar F, Soydemir E. Evaluation of the relationship between shear wave elastography measurements with laboratory and Doppler US parameters in patients with adult Hashimoto’s thyroiditis. Turk J Med Sci 2021; 51:778-786. [PMID: 33244946 PMCID: PMC8203158 DOI: 10.3906/sag-2008-210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/26/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim Hashimoto thyroiditis (HT) is an autoimmune disease that leads to tissue stiffening secondary to lymphocyte infiltration of the thyroid gland. Gray-scale ultrasound (US) is widely used in its diagnosis. Numerous studies have been conducted comparing elastography findings of HT with tissue stiffness and immunoreactivity levels. This study aims to reveal the relationship between shear wave elastography (SWE) and Doppler parameters in patients with HT. Materials and methods The study group consisted of 45 patients diagnosed with HT, and 20 control patients without thyroid pathology. Thyroid-stimulating hormone (TSH) and antithyroid peroxidase (TPO) values were examined in patients with HT. Thyroid gland volume and echo patterns were evaluated in the gray-scale US. Doppler measurements –peak systolic velocity (Vmax), end-diastolic velocity (Vmin), pulsatility index (PI), resistivity index (RI)– from the superior thyroidal artery and SWE measurements were taken from both thyroid lobes. Results The mean age of men and women in the HT group was 44.8 and 43.4 years. The mean TSH value (normal value: 0.3–4.2 uIU/ mL) was 3.90 ± 6.6 uIU/mL, and the anti-TPO value (normal value: < 35 IU/mL) was 235.47 ± 271.12 IU/mL. The average thyroid gland volume was 10.12 ± 2.71 mL in the HT group and 6.62 ± 2.11 mL in the control group (P = 0.034). HT group mean Vmax, mean Vmin, mean PI and RI values were significantly lower compared to normal subjects (P = 0.022, P = 0.026, P = 0.042, P = 0.046, respectively). The average SWE value of the thyroid gland was 24.56 ± 18.04 kPa in the experimental group and 7.34 ± 3.54 (P < 0.05) in the control group. Conclusion A positive correlation was found between PI and RI values and elastography values. An increase in SWE and decreases in Vmax and Vmin were found as high diagnostic value for HT.
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Affiliation(s)
| | - Ferhan Mantar
- Department of Endocrinology, VKV American Hospital, İstanbul, Türkiye
| | - Efe Soydemir
- Department of Radiology, Ministry of Health-Marmara University Pendik Education and Research Hospital, İstanbul, Türkiye
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Santos TARR, Marui S, Watanabe T, Lima N, Ozaki CO, Cerri GG, Chammas MC. Color Duplex Doppler US can Follow up the Response of Radioiodine in Graves' Disease by Evaluating the Thyroid Volume and Peak Systolic Velocity. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:658-667. [PMID: 31137051 DOI: 10.1055/a-0902-4842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The objective of this study was to prove the efficacy of Doppler ultrasonography (US-Doppler) in the follow-up of patients with GD treated with radioactive iodine. METHODS 97 patients (77 female and 20 male) with a mean age of 42 years (SD ± 15) and with prior diagnosis of GD were treated with radioiodine. In total, 88.5 % achieved euthyroidism or hypothyroidism after treatment. The study was documented before treatment and one, three, and six months after treatment with radioactive iodine (131I) by a single investigator. The volume, echogenicity, echotexture and vascularization of the glands as well as the peak systolic velocity (PSV) of the inferior thyroid arteries were evaluated and compared with the laboratory data. RESULTS Thyroid volume and PSV had a statistically significant correlation with hormone levels (p < 0.05). The mean pre-dose therapeutic thyroid volume was 43.01 ± 3.88 cm3 and was 11.58 ± 11.26 cm3 6 months after treatment. The mean PSV before 131I was 90.06 ± 44.13 cm/s and decreased significantly over time (p < 0.001). Six months after the therapeutic dose, the mean PSV was 32.95 ± 16.36 cm/s. However, the subjective parameters did not have a significant correlation with the normalization of the thyroid hormones. CONCLUSION Doppler US was useful for monitoring the therapeutic response of GD patients after treatment with radioiodine by evaluating the thyroid volume and peak systolic velocity.
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Affiliation(s)
| | - Suemi Marui
- Laboratory of Cellular and Molecular Endocrinology (LIM 25), Clinical Hospital of the Medical School of the University of São Paulo, Sao Paulo, Brazil
| | - Tomoco Watanabe
- Radiology Institute, Clinical Hospital of the Medical School of the University of São Paulo, Sao Paulo, Brazil
| | - Nicolau Lima
- Endocrinology Institute, Clinical Hospital of the Medical School of the University of São Paulo, Sao Paulo, Brazil
| | | | - Giovanni Guido Cerri
- Radiology Institute, Clinical Hospital of the Medical School of the University of São Paulo, Sao Paulo, Brazil
| | - Maria C Chammas
- Radiology Institute, Clinical Hospital of the Medical School of the University of São Paulo, Sao Paulo, Brazil
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Chung J, Lee YJ, Choi YJ, Ha EJ, Suh CH, Choi M, Baek JH, Na DG. Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology. Ultrasonography 2020; 39:315-330. [PMID: 32892523 PMCID: PMC7515666 DOI: 10.14366/usg.20072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Doppler ultrasonography (US) is widely used for the differential diagnosis of thyroid nodules, metastatic cervical lymph nodes in patients with thyroid cancer, and diffuse parenchymal disease, as well as for guidance in various US-guided procedures, including biopsy and ablation. However, controversies remain regarding the appropriate use and interpretation of Doppler US. Therefore, the Korean Society of Thyroid Radiology organized a taskforce to develop a consensus statement on the clinical use of Doppler US for thyroid disease. The review and recommendations in this article are based on a comprehensive analysis of the current literature and the consensus of experts.
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Affiliation(s)
- Jin Chung
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.,Human Medical Imaging and Intervention Center, Seoul, Korea
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Chekalina NI, Burmak YH, Petrov YY, Borysova ZO, Trybrat TA, Shut SV, Kazakov YM. Justification of Increasing the Blood Flow Velocity in the Arteries of the Thyroid Gland in Autoimmune Thyroiditis as a Reflection of Endothelial Changes Due to Inflammatory Status. Curr Med Imaging 2020; 15:61-65. [PMID: 31964328 DOI: 10.2174/1573405613666170921165445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the research was to determine the dependence of the blood flow velocity in the thyroid arteries in patients with Autoimmune Thyroiditis (AIT) on the presence of atherosclerotic carotid disease and the level of systemic blood pressure. METHODS The research involved 20 patients with AIT in euthyroid state, 30 patients AIT in euthyroid state with stable Coronary Heart Disease (CHD), 30 patients with stable CHD and 30 healthy individuals. Participants of the research were examined using ultrasound of carotid arteries and inferior thyroid arteries. Parameters of blood flow velocity were compared with the level of systemic blood pressure. RESULTS In AIT peak systolic velocity and resistance index in the inferior thyroid arteries were significantly higher than in healthy individuals and patients with CHD (p<0.05). In patients with CHD velocity parameters in carotid arteries were high, unlike in the healthy individuals and patients with AIT (p<0.05). In patients with AIT without CHD the atherosclerotic changes of carotid arteries were not found. Increased systemic blood pressure was noticed in all patients with CHD without significant differences between groups. CONCLUSION The value of peak systolic velocity and resistance index of inferior thyroid arteries in autoimmune thyroiditis are noticed even with euthyroidism and do not depend on systemic blood pressure and atherosclerosis of carotid arteries. Increasing the thyroid arterial blood flow velocity parameters should be considered as sign of an active inflammatory period AIT, where advanced fibrosis is not present.
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Affiliation(s)
- Nataliia I Chekalina
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Yurii H Burmak
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Yeuhen Ye Petrov
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Zinaiida O Borysova
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Tetiana A Trybrat
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Svitlana V Shut
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
| | - Yurii M Kazakov
- Department of Propaedeutics of Internal Medicine with Care for Patients, General Practice (Family Medicine), Medical Faculty, Higher State Educational Establishment of Ukraine, "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
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10
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Tamatea JAU, Reid P, Conaglen JV, Elston MS. Thyrotoxicosis in an Indigenous New Zealand Population - a Prospective Observational Study. J Endocr Soc 2020; 4:bvaa002. [PMID: 32161829 PMCID: PMC7060792 DOI: 10.1210/jendso/bvaa002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background Reported international incidence rates of thyrotoxicosis vary markedly, ranging from 6 to 93 cases per 100 000 per annum. Along with population demographics, exposures, and study design factors, ethnicity is increasingly being recognized as a potential factor influencing incidence. This study aimed to document the epidemiology and clinical presentation of thyrotoxicosis for Māori, the indigenous population in New Zealand. Methods A prospective study of adult patients presenting with a first diagnosis of thyrotoxicosis between January 2013 and October 2014 to a single New Zealand center. Demographic data were collected, and detailed clinical assessment performed. Results With 375 patients, an incidence rate of thyrotoxicosis of 73.0 per 100 000 per annum was identified. Of these, 353 (94.1%) participated in the study. The median age of the cohort was 47 years, 81% were female, and 58% had Graves disease. The overall incidence of thyrotoxicosis for Māori, the indigenous people of New Zealand, was higher than non-Māori (123.9 vs 57.3 per 100 000 per annum). Rates of both Graves disease and toxic multinodular goiter were higher in Māori as compared to non-Māori (incidence rate ratios of 1.9 [1.4, 2.6] and 5.3 [3.4, 8.3], respectively), with this increase being maintained after controlling for age, deprivation, and smoking. Conclusions Māori, the indigenous people of New Zealand, have an increased incidence of thyrotoxicosis compared to non-Māori and, in particular, toxic multinodular goiter. A greater understanding of the epidemiology of thyrotoxicosis in other indigenous and marginalized ethnic groups may help to optimize therapeutic pathways, equitable care and outcomes.
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Affiliation(s)
- Jade A U Tamatea
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand.,Te Kupenga Hauora Māori, Tamaki Campus, University of Auckland Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Tamaki Campus, University of Auckland Auckland, New Zealand
| | - John V Conaglen
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand
| | - Marianne S Elston
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand
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11
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Yuksekkaya R, Celikyay F, Gul SS, Yuksekkaya M, Kutluturk F, Ozmen C. Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves' Disease. Curr Med Imaging 2020; 16:1111-1124. [PMID: 32107993 DOI: 10.2174/1573405616666200124121546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Graves' Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive. OBJECTIVES To investigate the thyroid blood flow in patients with Graves' Disease by color Doppler Ultrasonography and a newly developed software Color Quantification. METHODS Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated. RESULTS The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all). CONCLUSION The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves' Disease.
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Affiliation(s)
- Ruken Yuksekkaya
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Celikyay
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Serdar S Gul
- Department of Nuclear Medicine, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mehmet Yuksekkaya
- Department of Biomedical Engineering, Faculty of Engineering, Baskent University, Ankara, Turkey
| | - Faruk Kutluturk
- Department of Endocrinology and Metabolism, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Cansel Ozmen
- Department of Biochemistry, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Hefeda MM. Value of the New Elastography Technique using Acoustic Radiation Force Impulse in Differentiation between Hashimoto's Thyroiditis and Graves' Disease. J Clin Imaging Sci 2019; 9:17. [PMID: 31448168 PMCID: PMC6702860 DOI: 10.25259/jcis-22-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background and Aim: This study was performed to evaluate the role and accuracy of shear wave elastography in the differentiation between Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), in comparison with the B-mode ultrasound and color Doppler ultrasound. Materials and Methods: This study was non-randomized prospective study. The study included 30 patients with GD, 65 patients with HT, and 35 patients with normal thyroid glands. Assessment of ultrasonographic criteria, color Doppler flow pattern, and shear patterns differed significantly between the control group and the group of diffuse thyroid disease (P < 0.001). The most specific sign for diagnosing HT was nodularity (97.87%), and the most sensitive sign was coarse echotexture (81.54%). Color Doppler flow (CDF) showed sensitivity of 91.8%, specificity of 56.92%, positive predictive value of 52.54%, negative predictive value of 92.5%, and diagnostic accuracy of 68.69% in the differentiation between GD and HT. The mean shear wave velocity (SWV) was 2.61 ± 0.32 m/s in the GD group (range: 2.1–3.21 m/s), 2.85 ± 0.52 m/s in the HT group (range: 2.31–3.82 m/s), and 1.75 ± 0.37 m/s in the control group (range: 1.24–2.36 m/s). The mean SWVs in the GD and HT groups were significantly higher than that in the control group (P < 0.001). The mean SWV in the HT group was higher than that in the GD group (P = 0.03). Conclusion: Quantitative and qualitative SWE is useful for diagnosing diffuse thyroid disease and evaluating the degree of fibrosis in autoimmune thyroiditis. However, acoustic radiation force impulse techniques cannot differentiate between HT and GD reliably.
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Vita R, Di Bari F, Perelli S, Capodicasa G, Benvenga S. Thyroid vascularization is an important ultrasonographic parameter in untreated Graves' disease patients. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2019; 15:65-69. [PMID: 30792955 PMCID: PMC6370557 DOI: 10.1016/j.jcte.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 01/01/2023]
Abstract
Graves’ disease is characterized by two sonographic features, hypoechogenicity and increased blood flow. The aim of this study was to review retrospectively ultrasound features and biochemical data of a cohort of untreated Graves’ disease patients. We reviewed charts of 42 such patients, who were referred to our Endocrinology Unit from January 2013 to May 2018. One operator performed all the thyroid sonographic scans. Serum TSH, FT3, FT4 and TSH-receptor antibodies (TRAb) levels at the time of ultrasound examination were evaluated. Over a mean follow-up of 30.9 months, about one in three patients (38%) experienced at least one recurrence of hyperthyroidism (1.4 ± 0.6 recurrence per patient), either on or off antithyroid drugs. We found that thyroid vascularization correlated directly with thyroid volume and that larger thyroids tended to be more vascularized. We also found that greater vascularization was associated with marked hypoechogenicity, and greater FT4 and TRAb levels. Patients who experienced recurrence(s) had 1.7-fold higher levels of TRAb at onset. In conclusion, thyroid hypervascularization at onset of Graves’ disease is an important sonographic feature.
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Affiliation(s)
- Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125 Messina, Italy
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125 Messina, Italy
| | - Sarah Perelli
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125 Messina, Italy
| | - Giovanni Capodicasa
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125 Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125 Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Viale Gazzi, 98125 Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125 Messina, Italy
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14
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Goichot B, Leenhardt L, Massart C, Raverot V, Tramalloni J, Iraqi H. Diagnostic procedure in suspected Graves' disease. ANNALES D'ENDOCRINOLOGIE 2018; 79:608-617. [PMID: 30220410 DOI: 10.1016/j.ando.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diagnostic procedure in suspected Graves' disease has never been studied scientifically and actual practice seems quite variable, notably between countries. Recommendations are few and weak (expert opinion). This article presents the recommendations of an expert consensus meeting organized by the French Society of Endocrinology in 2016. In case of clinically suspected thyrotoxicosis, the first-line biological assessment is of thyroid-stimulating hormone (TSH). Free T4 and possibly free T3 assays assess biological severity and are necessary for treatment efficacy monitoring. Positive diagnosis of Graves' disease after biological confirmation of thyrotoxicosis does not always require complementary etiological examinations if clinical presentation is unambiguous, notably including extra-thyroid signs. Otherwise, first-line anti-TSH-receptor (TSH-R) antibody screening is recommended for its good intrinsic performance (sensitivity and specificity) and ease of access in France. Scintigraphy is reserved to rare cases of Graves' disease with negative antibody findings or when another etiology is suspected. Thyroid ultrasound scan may be contributive, but is not recommended in first line.
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Affiliation(s)
- Bernard Goichot
- Service de médecine interne, endocrinologie et nutrition, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France.
| | - Laurence Leenhardt
- Unité thyroïde tumeurs endocrines, institut E3M, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Catherine Massart
- Service de biochimie-toxicologie, laboratoire d'hormonologie, CHU de Rennes, 35033 Rennes Cedex 09, France
| | - Véronique Raverot
- Service de biochimie et biologie moléculaire, laboratoire d'hormonologie, groupement hospitalier Est, CHU de Lyon, 69500 Bron, France
| | | | - Hinde Iraqi
- Service d'endocrinologie, CHU de Rabat, Rabat, Morocco
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15
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The End-Diastolic Velocity of Thyroid Arteries Is Strongly Correlated with the Peak Systolic Velocity and Gland Volume in Patients with Autoimmune Thyroiditis. J Thyroid Res 2017; 2017:1924974. [PMID: 29062583 PMCID: PMC5618767 DOI: 10.1155/2017/1924974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance. Objective The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT). Methods A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography. Results The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, r = 0.919), thyroid volume (r = 0.711), and thyroid visual vascularization pattern (TVP, r = 0.687). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg. Conclusion The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.
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Gaberšček S, Osolnik J, Zaletel K, Pirnat E, Hojker S. An Advantageous Role of Spectral Doppler Sonography in the Evaluation of Thyroid Dysfunction During the Postpartum Period. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1429-1436. [PMID: 27208199 DOI: 10.7863/ultra.15.07033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of spectral Doppler sonography in women with thyroid dysfunction during the first postpartum year. METHODS This prospective observational clinical study included 83 consecutive untreated women: 32 with hyperthyroid postpartum thyroiditis, 32 with hypothyroid postpartum thyroiditis, and 19 with Graves disease, which first appeared within 12 months after delivery. Thyrotropin, free thyroid hormones, thyroid peroxidase antibodies, thyroglobulin antibodies, and thyrotropin receptor antibodies were measured. With a 7.5-MHz linear transducer, we measured the thyroid volume and peak systolic velocity (PSV) at the level of intrathyroid arteries. RESULTS Hyperthyroid postpartum thyroiditis appeared significantly earlier (mean ± SD, 4.4 ± 1.9 months after delivery) than hypothyroid postpartum thyroiditis (6.5 ± 2.1 months) and Graves disease (7.2 ± 2.7 months; P< .001). The thyroid volume in hyperthyroid postpartum thyroiditis (9.7 ± 6.3 mL) was significantly lower than in hypothyroid postpartum thyroiditis (14.7 ± 10.2 mL; P = .030) and Graves disease (19.4 ± 10.2 mL; P< .001). The PSV in hyperthyroid postpartum thyroiditis (9.4 ± 3.4 cm/s) was significantly lower than in hypothyroid postpartum thyroiditis (14.4 ± 3.9 cm/s; P < .001) and Graves disease (19.8 ± 7.0 cm/s; P < .001). With a cutoff level of 15 cm/s, the sensitivity and specificity of the PSV as a predictor of the correct diagnosis in hyperthyroid postpartum women were 94.7% and 96.8%, respectively. A multinomial logistic regression revealed PSV and the time after delivery at which the disorders presented as independent predictors of the differentiation between hyperthyroid postpartum thyroiditis and Graves disease (P = .003; P = .022). CONCLUSIONS Spectral Doppler sonography was shown to be a useful and accurate method for thyroid dysfunction evaluation during the postpartum period.
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Affiliation(s)
- Simona Gaberšček
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Osolnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Edvard Pirnat
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sergej Hojker
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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17
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The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism. Ann Med Surg (Lond) 2016; 9:53-7. [PMID: 27408715 PMCID: PMC4932873 DOI: 10.1016/j.amsu.2016.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
AIM To investigate the effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism. MATERIAL AND METHODS This controlled, randomized, prospective cohort was carried out on 40 patients who admitted for surgery due to hyperthyroidism. Cases were randomly assigned to receive either preoperative treatment with Lugol solution (Group 1) or no preoperative treatment with Lugol solution (Group 2). Group 3 (n = 10) consisted of healthy adults with no known history and signs of hyperthyroidism. Blood flow through the thyroid arteries of patients was measured by color flow Doppler ultrasonography. Free T3, free T4, TSH, thyroid volume and the resistance index of the four main thyroid arteries were measured in all patients. RESULTS There was not a significant difference between gender, preoperative serum thyroid hormone levels, or thyroid gland volumes between groups 1 and 2. The mean blood flow of the patients in Group 1 was significantly lower than values in Group 2. When age, gender, thyroid hormone, TSH, thyroid volume, blood flow, and Lugol solution treatment were included as independent variables, Lugol solution treatment (OR, 7.40; 95% CI, 1.02-58.46; p = 0.001) was found to be the only significant independent determinant of intraoperative blood loss. Lugol solution treatment resulted in a 7.40-fold decrease in the rate of intraoperative blood loss. CONCLUSION Preoperative Lugol solution treatment was found to be a significant independent determinant of intraoperative blood loss. Moreover, preoperative Lugol solution treatment decreased the rate of blood flow, and intraoperative blood loss during thyroidectomy.
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18
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Kim TK, Lee EJ. The value of the mean peak systolic velocity of the superior thyroidal artery in the differential diagnosis of thyrotoxicosis. Ultrasonography 2015; 34:292-6. [PMID: 25971899 PMCID: PMC4603212 DOI: 10.14366/usg.14059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/27/2022] Open
Abstract
Purpose: The aim of this study was to validate the superior thyroidal artery mean peak systolic velocity (STA-mPSV) as an alternative to other diagnostic parameters in the differentiation of the causes of thyrotoxicosis in Korean patients. Methods: This study was conducted with newly diagnosed and untreated thyrotoxic patients. Forty patients were diagnosed with Graves disease (GD) and 20 patients with destructive thyroiditis (DT). Another 60 healthy subjects without thyroid disease participated as the control group. Blood samples were taken to evaluate the thyroid function and thyroid autoantibodies (TRAb). Twenty-four hour radioactive iodine uptake (RAIU) scanning was performed to confirm GD or DT. The STA-mPSV was measured using color Doppler ultrasonography. Results: The STA-mPSV was significantly higher in the untreated GD group than in the DT group (GD, 78.96±29.04 cm/sec; DT, 29.97±14.67 cm/sec; control, 17.55±4.99 cm/sec; P<0.001). The area under the curve (AUC) of the STA-mPSV for the differential diagnosis of untreated GD and DT was 0.9506 (optimal cutoff value, 41.3 cm/sec; sensitivity, 95%, 38/40; specificity, 85%, 17/20) in the receiver operating characteristic analysis. The AUC values of the STA-mPSV, RAIU, and TRAb were 0.9506, 1, and 0.9988, respectively (P=0.159). Conclusion: In clinical practice, the STA-mPSV has a diagnostic value similar to that of the TRAb and 24-hour RAIU in the differential diagnosis of newly diagnosed Korean thyrotoxic patients.
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Affiliation(s)
- Tae Kyoon Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Eun Ju Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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19
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Banaka I, Thomas D, Kaltsas G. Value of the left inferior thyroid artery peak systolic velocity in diagnosing autoimmune thyroid disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1969-1978. [PMID: 24154901 DOI: 10.7863/ultra.32.11.1969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to calculate a number of thyroid grayscale and Doppler sonographic parameters in healthy individuals and patients with Hashimoto thyroiditis or Graves disease and assess their sensitivity and specificity for the diagnosis of autoimmune thyroid disease using receiver operating characteristic curves. METHODS A consecutive series of 153 patients (70 euthyroid and 54 hypothyroid patients with Hashimoto thyroiditis and 29 patients with Graves disease), all selected from an outpatient endocrine clinic, and 48 age- and sex-matched healthy control participants were evaluated with grayscale and power Doppler sonography. RESULTS An irregular echo pattern in the thyroid parenchyma had 92.8% sensitivity for the diagnosis of autoimmune thyroid disease, and a left inferior thyroid artery peak systolic velocity (PSV) greater than 26.11 cm/s had 91.7% specificity. Of 8 patients with Hashimoto thyroiditis and normal grayscale sonographic characteristics, 6 had a left inferior thyroid artery PSV greater than 26.11 cm/s. A left inferior thyroid artery PSV greater than 61.65 cm/s had 82.8% sensitivity and 86.9% specificity for differentiating Hashimoto thyroiditis from Graves disease. CONCLUSIONS The left inferior thyroid artery PSV was the most accurate sonographic parameter for the diagnosis of autoimmune thyroid disease. Measurement of the inferior thyroid artery PSV could be used in patients with a normal grayscale sonographic appearance and inconclusive clinical and biochemical parameters to substantiate the diagnosis of autoimmune thyroid disease. Further studies are needed to evaluate and expand the use of this index.
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Affiliation(s)
- Ioanna Banaka
- Department of Pathophysiology, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece.
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Karakas O, Karakas E, Cullu N, Demir Y, Kucukyavas Y, Surucu E, Yener S, Igci E. An evaluation of thyrotoxic autoimmune thyroiditis patients with triplex Doppler ultrasonography. Clin Imaging 2013; 38:1-5. [PMID: 24119678 DOI: 10.1016/j.clinimag.2013.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/01/2013] [Accepted: 06/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the usefulness of blood flow parameters obtained from STA and CCA with Triplex Doppler ultrasonography (TDU) on patients with thyrotoxicosis. MATERIALS AND METHODS This cross-sectional study included consecutive 24 patients with thyrotoxicosis and 18 healthy controls. The thyroid gland blood flow parameters were evaluated with TDU. RESULTS The thyroid volumes and FT3, TRAb, 4-h and 24-h radioactive iodine uptake (RAIU) levels of Group 1 were significantly high compared to those of Group 2. The thyroid volumes and FT3, FT4 and TSH levels of both Group 1 and Group 2 showed a statistically significant difference compared to Group 3. STA-PSV values for Group 1, Group 2 and Group 3 were 138 cm/s, 54 cm/s and 37 cm/s, respectively. STA-EDV values for these groups were 60 cm/s, 25 cm/s and 15 cm/s, respectively. PSVR values for these groups were 1.01, 0.45, 0.34 cm/s, respectively. EDVR values for these groups were 1.29, 0.70 and 0.49 cm/s, respectively. In Group 1, STA-PSV, STA-EDV, PSVR and EDVR values were significantly high compared to those of Group 2. RAIU levels showed a significant positive correlation with the STA-PSV, STA-EDV and PSVR. CONCLUSION The thyroid gland blood flow parameters may be used in clinical diagnosis of patients with thyrotoxicosis.
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Affiliation(s)
- Omer Karakas
- Faculty of Medicine, Department of Radiology, Harran University, Sanliurfa, Turkey.
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21
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Mavragani CP, Niewold TB, Chatzigeorgiou A, Danielides S, Thomas D, Kirou KA, Kamper E, Kaltsas G, Crow MK. Increased serum type I interferon activity in organ-specific autoimmune disorders: clinical, imaging, and serological associations. Front Immunol 2013; 4:238. [PMID: 23966997 PMCID: PMC3746787 DOI: 10.3389/fimmu.2013.00238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/02/2013] [Indexed: 01/27/2023] Open
Abstract
Background: Activation of the type I interferon (IFN) pathway has been implicated in the pathogenesis of systemic autoimmune disorders but its role in the pathogenesis of organ-specific autoimmunity is limited. We tested the hypothesis that endogenous expression of type I IFN functional activity contributes to the pathogenesis of autoimmune thyroid disease (ATD) and type I diabetes (T1DM). Methods: We studied 39 patients with ATD and 39 age and sex matched controls along with 88 T1DM patients and 46 healthy matched controls respectively. Available clinical and serological parameters were recorded by chart review, and thyroid ultrasound was performed in 17 ATD patients. Type I IFN serum activity was determined in all subjects using a reporter cell assay. The rs1990760 SNP of the interferon-induced helicase 1 gene was genotyped in ATD patients. Results: Serum type I IFN activity was increased in patients with ATD and T1DM compared to controls (p-values: 0.002 and 0.04, respectively). ATD patients with high type I IFN serum activity had increased prevalence of antibodies against thyroglobulin (anti-Tg) and cardiopulmonary manifestations compared to those with low IFN activity. Additionally, the presence of micronodules on thyroid ultrasound was associated with higher type I IFN levels. In patients with T1DM, high IFN levels were associated with increased apolipoprotein-B levels. Conclusion: Serum type I IFN activity is increased in ATD and T1DM and is associated with specific clinical, serological, and imaging features. These findings may implicate type I IFN pathway in the pathogenesis of specific features of organ-specific autoimmunity.
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Affiliation(s)
- Clio P Mavragani
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery , New York, NY , USA ; Department of Physiology, School of Medicine, University of Athens , Athens , Greece
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Sarikaya B, Demirbilek H, Akata D, Kandemir N. The role of the resistive index in Hashimoto's thyroiditis: a sonographic pilot study in children. Clinics (Sao Paulo) 2012; 67. [PMID: 23184199 PMCID: PMC3488981 DOI: 10.6061/clinics/2012(11)05] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The role of Doppler ultrasonography in the diagnosis of diffuse thyroid diseases is not well established. In particular, Doppler ultrasonography findings in children with Hashimoto's thyroiditis are very limited. We examined gray-scale and Doppler ultrasound findings in Hashimoto's thyroiditis in children in an attempt to understand the feasibility of future prospective controlled studies. MATERIALS AND METHODS Twenty-one children with newly diagnosed Hashimoto's thyroiditis were recruited in the study. The patients were euthyroid or had subclinical hypothyroidism at the time of the ultrasonography examination. According to the color Doppler scale developed by Schulz et al., thyroid glands were classified into four patterns based on visual scoring and the mean resistive index (RI), which was calculated via measurements from both lobes, and these results were compared with gray-scale findings. RESULTS The mean RI value, calculated as the mean of the RI values of both lobes obtained from each patient, was found to be 0.57 ± 0.05 (range 0.48-0.67) cm/sn. The distribution of thyroid classifications was as follows: Pattern 0, n = 7; Pattern I, n = 6; Pattern II, n = 4; and Pattern III ("thyroid inferno"), n = 4. The mean RI values in patients with normal or near-normal gray-scale findings (n = 10) and patients with more substantial gray-scale changes (n = 11) were not significantly different and were lower than the values in normal children previously presented in the literature. CONCLUSION The results indicated that the RI may be more sensitive than other ultrasound parameters for the diagnosis of Hashimoto's thyroiditis.
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Affiliation(s)
- Basar Sarikaya
- Department of Radiology, Medical Faculty, Hacettepe University, Ankara, Turkey.
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Ishay A, Pollak Y, Chervinsky L, Lavi I, Luboshitzky R. Color-flow doppler sonography in patients with subclinical thyroid dysfunction. Endocr Pract 2010; 16:376-81. [PMID: 20061297 DOI: 10.4158/ep09218.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the value of color-flow Doppler sonography (CFDS) in evaluating intrathyroidal blood flow and velocity in patients with subclinical thyroid dysfunction. METHODS In this prospective study, patients with subclinical hypothyroidism, patients with subclinical hyperthyroidism, and euthyroid patients without known thyroid autoimmune disease who served as controls were included. Subclinical thyroid dysfunction was defined as normal se-rum free thyroxine (FT4) and free triiodothyronine (FT3) in the presence of high (subclinical hypothyroidism), or low-suppressed (subclinical hyperthyroidism) serum thyrotropin (TSH) levels. Serum FT4, FT3, TSH, and antibodies to thyroid peroxidase and thyroglobulin were measured in all participants. In addition, TSH receptor antibody levels were determined in patients with subclinical hyperthyroid-ism. All participants underwent conventional sonography and CFDS. Mean peak systolic velocity (PSV) and resistive index were obtained from multiple extranodular thyroid parenchyma samplings and inferior thyroid artery measurements. RESULTS The study population included 27 patients with subclinical hypothyroidism, 15 patients with subclinical hyperthyroidism, and 20 euthyroid patients. Patients with subclinical hypothyroidism had significantly higher mean intrathyroidal PSV values than control patients (19.9 +/- 5.6 cm/s vs 15.7 +/- 4.4 cm/s; P = .008), whereas patients with subclinical hyperthyroidism had significantly higher mean PSV values than control patients at the inferior thyroid artery level (29.7 +/- 10.7 cm/s vs 21.9 +/- 6.8 cm/s; P = .014). Compared with control patients, a greater proportion of patients with subclinical hypothyroidism and patients with subclinical hyperthyroidism had marked CFDS patterns (78% vs 15% [P<.001] and 53% vs 15%; [P<.001], respectively). A significant association was found between positivity for thyroid autoantibodies and intense CFDS patterns. No correlation was found between TSH or thyroid hormone levels and CFDS pattern or blood flow velocity. CONCLUSION We have demonstrated that significantly increased thyroid blood flow velocity and vascularity are already present in patients with mild thyroid dysfunction.
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Affiliation(s)
- Avraham Ishay
- ndocrine Institute, Haemek Medical Center, Afula, Israel.
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Anatomical Asymmetry in Goiter: A Demonstration by Three-dimensional Power Doppler Ultrasound. J Med Ultrasound 2010. [DOI: 10.1016/s0929-6441(10)60004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Schraml C, Müssig K, Martirosian P, Schwenzer NF, Claussen CD, Häring HU, Balletshofer BM, Schick F. Autoimmune thyroid disease: arterial spin-labeling perfusion MR imaging. Radiology 2009; 253:435-42. [PMID: 19789231 DOI: 10.1148/radiol.2533090166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess thyroid perfusion in patients with autoimmune thyroid diseases compared with that in healthy control subjects by using an arterial spin-labeling (ASL) magnetic resonance (MR) technique and to assess whether thyroid perfusion is associated with endocrine laboratory abnormalities. MATERIALS AND METHODS This study was approved by the local institutional review board. All participants gave written informed consent. Perfusion imaging of the thyroid gland was performed in 10 patients with Graves disease (GD) and 10 patients with Hashimoto thyroiditis (HT). Ten healthy individuals served as control subjects. Perfusion imaging was performed with a 1.5-T MR unit by using a flow-sensitive alternating inversion recovery-true fast imaging with steady-state precession technique. Perfusion maps of the entire thyroid gland were calculated on the basis of extended Bloch equations. Analysis of variance with a post hoc test (Tukey honestly significant difference) was performed to assess differences in perfusion between groups. Associations between perfusion and laboratory parameters were analyzed with univariate regression analysis. RESULTS Mean thyroid perfusion was 1596 mL/min/100 g +/- 436 (standard deviation) in patients with GD, 825 mL/min/100 g +/- 264 in patients with HT, and 491 mL/min/100 g +/- 89 in healthy control subjects. Perfusion was significantly higher in patients with GD (P < .0001) and those with HT (P < .05) than in control subjects. A significant difference in thyroid perfusion was detected between the two autoimmune entities (P < .0001). In patients with GD, significant associations were found between perfusion and serum concentrations of free thyroid hormones and anti-thyroid-stimulating hormone receptor antibodies (P < .05 for all). CONCLUSION Quantitative ASL perfusion imaging of the thyroid gland revealed significant perfusion differences in the autoimmune thyroid diseases GD and HT. Absolute quantification of thyroid perfusion may be useful in the clinical assessment of autoimmune thyroid disorders and when monitoring therapeutic treatment in GD.
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Affiliation(s)
- Christina Schraml
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, and Division of Endocrinology, Diabetes, Nephrology, Angiology, and Clinical Chemistry, University Hospital of Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany.
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Chiou SC, Hsieh MH, Chen HY, Lin JD, Chen CC, Hsu WH, Jeng LB, Chang CT, Chen RH, Wang TY, Haung WL. The reproducibility of the virtual organ computer-aided analysis program for evaluating 3-dimensional power Doppler ultrasonography of diffuse thyroid disorders. J Endocrinol Invest 2009; 32:139-46. [PMID: 19411812 DOI: 10.1007/bf03345703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to evaluate the intra- observer and inter-observer reproducibility of 3-dimensional (3D) power Doppler ultrasonography with the virtual organ computer-aided analysis (VOCAL) program for measuring thyroid volume and vascular indices in patients with diffuse thyroid disorders. MATERIALS AND METHODS Patients with diffuse goiters were examined by 3D ultrasonography from August 2005 to July 2006. The parameters for vascular assessment included the vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and thyroid size, and were obtained using the VOCAL program. This program used plane A and a 30 degrees rotational step. Intra-observer and inter-observer repeatability are presented as intra-class correlation coefficient (intra-CC) and inter-class correlation coefficient (inter-CC), with values >0.70 being acceptable. RESULTS Sixty-three patients in total were enrolled for this study, including 19 patients with simple goiter and 44 patients with autoimmune thyroid disease (AITD) (23 Graves' disease, 21 Hashimoto's thyroiditis). Thyroid volume and 3 vascular indices showed excellent reproducibility in the AITD group (intra- CC>0.9373 and inter-CC>0.8763) and its subgroups. The VI had excellent consistent reproducibility in the simple goiter group (intra-CC>0.8987 and inter-CC>0.8881), but the other parameters did not. CONCLUSIONS Based on this study, 3D power Doppler ultrasonography with the VOCAL program is a reliable tool for evaluating diffuse thyroid disorders due to an autoimmune process. The VI is the most reliable parameter.
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Affiliation(s)
- S-C Chiou
- Division of Endocrinology and Metabolism, China Medical University Hospital, Taichung, Taiwan.
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Wu CC. Duplex Doppler Ultrasonography for the Functional Evaluation of Diffuse Thyroid Diseases. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60126-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Turgut AT, Çakal E, Koşar U, Koşar P, Demirbaş B, Aral Y. Maximum Systolic Velocity of Inferior Thyroid Artery and Thyroideal Color Doppler Flow Pattern in Hypothyroid Subjects Before and After Treatment. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60014-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Corona G, Biagini C, Rotondi M, Bonamano A, Cremonini N, Petrone L, Conforti B, Forti G, Serio M. Correlation between, clinical, biochemical, color Doppler ultrasound thyroid parameters, and CXCL-10 in autoimmune thyroid diseases. Endocr J 2008; 55:345-50. [PMID: 18379127 DOI: 10.1507/endocrj.k07e-052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE the aim of present study is to determine possible contributions of INF-gamma inducible chemochine CXCL-10 in the thyroid color doppler ultrasound (CDU) parameters typical of autoimmune disorders. METHODS we studied a consecutive series of 25 patients with autoimmune thyroid disease and 10 healthy control subjects. All subjects underwent a thyroid CDU examination by the same investigator, who was unaware of the laboratory values at the time of the examination. Moreover, all subjects underwent a clinical evaluation, CXCL-10 and thyroid hormonal assessment. RESULTS CXCL-10 levels were significantly higher in patients with autoimmune diseases and as well as in subjects with an increased thyroid vascularization at CDU. Moreover, CXCL-10 levels were significantly (p<0.05) correlated with inferior thyroid arteria peak systolic velocity (ITA-PSV; r = 0.376) and with thyroid volume even after adjustment for confounding factors. No difference was observed between vascular thyroid pattern at CDU and thyroid circulating hormones while, ITA-PSV was significantly associated with TSH (Adj. r = -0.373; p<0.05). CONCLUSIONS our data seem to suggest that CXCL-10 could play an important role in the intra-thyroid angiogenesis modulation, explaining, at least partiality, CDU findings typical of thyroid autoimmune diseases. Moreover we confirmed previous reports considering ITA-PSV as the best CDU parameters in the differential diagnosis of thyroid autoimmune disorders.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Erbil Y, Giriş M, Salmaslıoglu A, Ozluk Y, Barbaros U, Yanık BT, Kapran Y, Abbasoglu SD, Ozarmagan S. The effect of anti-thyroid drug treatment duration on thyroid gland microvessel density and intraoperative blood loss in patients with Graves' disease. Surgery 2008; 143:216-25. [DOI: 10.1016/j.surg.2007.07.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 11/16/2022]
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Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmağan S, Tezelman S. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease. J Clin Endocrinol Metab 2007; 92:2182-9. [PMID: 17389702 DOI: 10.1210/jc.2007-0229] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although some endocrine surgeons administer Lugol solution to decrease thyroid gland vascularity, there is still not an agreement on its effectiveness. OBJECTIVE The aims of this clinical trial are to evaluate thyroid blood flow and microvessel density in patients with Graves' disease who received Lugol solution treatment preoperatively. DESIGN This was a prospective clinical trial. SETTING This clinical trial took place at a tertiary referral center. METHOD Thirty-six patients were randomly assigned to receive either preoperative treatment with Lugol solution (group 1, n = 17) or no preoperative treatment with Lugol solution (group 2, n = 19). MAIN OUTCOME MEASURES Blood flow through the thyroid arteries of patients with Graves' disease was measured by color flow Doppler ultrasonography. The microvessel density (MVD) was assessed by immunohistochemical and Western blot analysis of the level of expression of CD-34 in thyroid tissue. The weight and blood loss of the thyroid gland were measured in all patients. RESULTS The mean blood flow, MVD, CD-34 expression, and blood loss in group 1 patients were significantly lower than those in group 2 patients. There was a negative correlation between Lugol solution treatment and blood flow (r(s) = -0.629; P = 0.0001), blood loss (r(s) = -0.621; P = 0.0001), MVD (r(s) = -0.865; P = 0.0001), and CD-34 expression (r(s) = -0.865; P = 0.0001). According to logistic regression analysis, Lugol solution treatment resulted in a 9.33-fold decreased rate of intraoperative blood loss. CONCLUSION Preoperative Lugol solution treatment decreased the rate of blood flow, thyroid vascularity, and intraoperative blood loss during thyroidectomy.
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Affiliation(s)
- Yeşim Erbil
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, 34093 Capa/Istanbul, Turkey.
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Erdoğan MF, Anil C, Cesur M, Başkal N, Erdoğan G. Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism. Thyroid 2007; 17:223-8. [PMID: 17381355 DOI: 10.1089/thy.2006.0104] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Color flow Doppler sonography (CFDS) is gaining importance for the functional evaluation of the thyroid disorders. We aimed to determine the value of CFDS for the etiological diagnosis of hyperthyroidism. Fifty-five patients with hyperthyroidism (29 Graves' disease [GD] and 26 toxic adenoma [TA]), 24 patients with Hashimoto's thyroiditis (HT), and 39 euthyroid controls were included. Etiological diagnoses were carried out using standard methods. Conventional gray scale sonography was performed, followed by CFDS. Doppler patterns of the glands were scored and peak systolic velocity (PSV) measurements were obtained from intrathyroidal, perithyroidal, and perinodular vasculature. Vascular patterns were significantly more prominent, and the mean PSV values were significantly higher in the GD patients compared to the HT patients ( p < 0.001) and controls ( p < 0.001). Perinodular and intranodular signals and the mean perinodular PSV values were significantly higher in TAs compared to controls. CFDS could differentiate the untreated GD from the HT, which had similar gray scale findings. Hot nodules could also be differentiated from cold nodules with more prominent vascular patterns and significantly higher PSV values. As an inexpensive, fast, and noninvasive imaging procedure, CFDS could be helpful in the initial clinical evaluation and may avoid scintigraphy in a substantial number of thyrotoxic patients.
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Affiliation(s)
- Murat Faik Erdoğan
- Ankara University, Medical School, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.
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Chiou SC, Peng YS, Chen PY, Ho C, Yeh HY, Chen CP, Lin JD. Color Doppler Ultrasonography of Inferior Thyroid Artery and Its Relation with Thyroid Functional State. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60091-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baldini M, Orsatti A, Bonfanti MT, Castagnone D, Cantalamessa L. Relationship between the sonographic appearance of the thyroid and the clinical course and autoimmune activity of Graves' disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:381-5. [PMID: 16240426 DOI: 10.1002/jcu.20157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study was to investigate the relationship between thyroid echogenicity and clinical course/immunologic parameters in Graves' disease. METHODS Two hundred and six outpatients with Graves' disease (31 men, 175 women; 46 +/- 23 years old) were studied with thyroid sonography and color Doppler sonography. Forty-five patients were treated for active hyperthyroidism, 161 were euthyroid (85 immediately before withdrawal of antithyroid drug at maintenance doses, 76 in stable remission after withdrawal of antithyroid treatment). Free triiodothyronine, free thyroxine, thyrotropin, and disease-specific autoantibodies (antithyrotropin-releasing hormone antibody) were determined in all patients. RESULTS The ultrasound images were classified on the basis of homogeneous, finely unhomogeneous, or micronodular appearance. The proportion of unhomogeneous plus micronodular patterns was greater in hyperthyroid (77.8%) than in euthyroid patients (62.1%). In the latter group, the pattern distribution was significantly different in patients who were antibody positive relative to patients who were antibody negative (p < 0.01). In the stable remission subgroup, the pattern distribution differed according to thyrotropin levels (p < .01). There was a correlation between echopattern and color Doppler sonography as vascularization variables progressively increased in the transition from homogeneous to unhomogeneous and micronodular echopattern (most evident echotexture changes). CONCLUSIONS A sonographic-based classification in Graves' disease can distinguish subgroups of patients with different clinical courses and disease activity. This procedure is easy to perform and correlates well with clinical findings.
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Affiliation(s)
- Marina Baldini
- Department of Internal Medicine, University of Milan, Division of Internal Medicine I, IRCCS Ospedale Maggiore, via F. Sforza 35, Milan, Italy
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Krejza J, Nowacka A, Szylak A, Bilello M, Melhem LY. Variability of thyroid blood flow Doppler parameters in healthy women. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:867-876. [PMID: 15313319 DOI: 10.1016/j.ultrasmedbio.2004.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Revised: 04/27/2004] [Accepted: 05/13/2004] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to estimate variability of flow Doppler parameters in the superior thyroid artery (STHA) during the menstrual cycle in young women and to explore the influence of endogenous 17-b-estradiol (E2) and progesterone (PRG) on the velocity waveform. The plasma concentration of these hormones was correlated with flow velocities, pulsatility index (PUI), resistance index (RI) and acceleration index (accI) and time (accT), which were measured with color-coded duplex sonography 8 times during the cycle in 14 healthy women (age range: 23 to 25 years). Coefficient of variation (CV), interclass correlation (ICC), repeatability (repC) and pooled Pearson correlation (r) coefficients were used to estimate the variability of the parameters. The highest variability was found for accI and accT: CV = 48% and 31%; ICC = 0.51 and 0.45; repC = 2.8 and 95; r = 0.37 and 0.4, respectively. The CV for flow velocities varied from 25% to 26%, ICC from 0.53 to 0.56, repC from 8 to 17 and r has a value of 0.46. The respective values for RI and PUI were: 11%, 18%; 0.48, 0.55; 0.15, 0.48; and 0.46, 0.48. The diastolic blood pressure decreased significantly by 7 mmHg (p < 0.01) in the luteal phase, whereas other physiological variables were stable during the cycle. Although the fluctuations of the flow parameters during the cycle were not statistically significant, a weak linear correlation between flow velocities and concentration of E2 was found; for mean velocity r = 0.16, p < 0.05. Impedance indices showed an increasing trend in the luteal phase, along with increase of the pulse pressure index (PPI). The results showed that variability of the flow parameters in the STHA is substantial and that higher flow velocities are associated with increase of plasma concentration of 17-b-estradiol during the menstrual cycle in young women.
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Affiliation(s)
- Jaroslaw Krejza
- Department of Radiology, Bialystok University School of Medicine, Bialystok, Poland.
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Schulz SL, Seeberger U, Hengstmann JH. Color Doppler sonography in hypothyroidism. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2003; 16:183-9. [PMID: 12573787 DOI: 10.1016/s0929-8266(02)00072-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The value of color Doppler sonography in thyroid disease continues to be a matter of debate. Over the past few years, several studies have proved unable to yield unequivocal results. Only a few studies concerning color Doppler sonography in patients with hypothyroidism have been published. METHODS 89 patients with hypothyroidism have been evaluated. They were examined clinically; laboratory tests on thyroid function and color Doppler sonography have been performed. The color flow distribution and intensity were estimated and the fastest flow velocity (PSV) detectable with a pw-doppler was registered. The color pattern was graded from 0 to III as has been described by others and the color Doppler findings were then correlated to both the clinical picture and the laboratory results. RESULTS 56 of the 89 hypothyroid patients showed pattern 0 with a PSV of 22 cm/s. In 33 patients different degrees of increased parenchymal color could be found with a concordant PSV: 16 patients showed pattern I with a PSV of 39 cm/s; 11 showed pattern II with PSV 58 cm/s, and 6 showed pattern III with PSV 63 cm/s. Regarding the corresponding clinical and laboratory variables, there was a very close correlation between color intensity and anti-Tg/anti-TPO antibody levels: pattern 0: anti-Tg 474 IU/ml, anti-TPO-Ab 810 IU/ml; pattern I: 1053/1733; pattern II: 1774/2432; pattern III: 1951/2633. Some correlation could also be found for the TSH values and the calculated volume of the thyroid gland, whereas the duration of hypothyroidism showed an inverse correlation to color intensity. (Pattern 0: TSH 3.1 mE/ml, volume 9.2 ml, duration 43 months; pattern I: 4.2 mE/l, 15.7 ml, 24 mos.; pattern II: 11.5 mE/l, 22.3 ml, 16 mos.; pattern III: 38.2 mE/l, 34.3 ml, 10 mos, respectively). CONCLUSIONS The color Doppler pattern of intense hypervascularization of the thyroid gland formerly attributed only to the hyperthyroid state of active Graves' Disease can also be seen in hypothyroidism. Our data support the concept that the color flow appearance is not the result of stimulated thyroid hormone production, but a measure of the activity of an autoimmune process.
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Affiliation(s)
- Susanne L Schulz
- Department of Medicine III, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967 Berlin, Germany.
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