Multiparametric ultrasound-based assessment of overt hyperthyroid diffuse thyroid disease

Introduction

Hyperthyroidismis a prevalent condition affecting global populations, with an overall prevalence of 1.2%. Our research aimed to establish a systematic diagnostic approach using multiparametric ultrasound (MPUS) to diagnose hyperthyroid diffuse thyroid disease (DTD).

Methods

We conducted a retrospective study from June 2021 to June 2023 at a specialized endocrinology center in Timisoara, Romania, enrolling subjects presenting with clinical hyperthyroidism. Using the Mach 30 Aixplorer ultrasound equipment, evaluations were performed initially in B-mode US, followed by Color Doppler and Spectral Doppler measurements, and finally, 2D Shear wave elastography (SWE).

Results

From the 218 patients analyzed, the diagnosis of DTD with hyperthyroidism was confirmed through biochemical assessment, subgrouping various pathologies such as subacute thyroiditis, Graves' disease, painless thyroiditis, Hashimoto's thyroiditis, iatrogenic, as well as healthy controls. In the first step, B-mode hypoechogenicity had an AUC of 0.951 for DTD detection. In the second step, the peak systolic velocity differentiated Graves' disease with a median of 42.4 cm/s and an AUC of 1. Lastly, the third step consisted of SWE evaluation, revealing a mean elasticity index in the SAT subgroup significantly higher from other subgroups (p<0.001) with an AUC of 1.

Conclusion

Our study offers a step-by-step evaluation algorithm for DTD diagnosis, with a very good overall diagnostic performance (AUC of 0.946).

Preliminary study of sound touch elastography in diffuse thyroid disease in children

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.

Validation of Diagnostic Performance and Interobserver Agreement of DTD-TIRADS for Diffuse Thyroid Disease on Ultrasound: A Single-Center Study

OBJECTIVE. This retrospective study aimed to investigate the capability of the already-proposed thyroid imaging reporting and data system for detecting diffuse thyroid disease (DTD-TIRADS) on ultrasound (US) by assessing interobserver agreement and diagnostic performance. MATERIALS AND METHODS. A total of 180 patients who underwent thyroid US before thyroid surgery were included. Three radiologists blinded to the pathologic and serologic data independently categorized the US features according to a four-category DTD-TIRADS classification system. On the basis of the pathologic results of thyroid parenchyma, diagnostic performance values were calculated using ROC curve analyses. Interobserver agreements of each US feature and DTD-TIRADS category among the three radiologists were also assessed. RESULTS. Of the 180 patients, 143 (79.4%) had normal thyroid parenchyma and 37 (20.6%) had diffuse thyroid disease (DTD). The areas under the ROC curve for DTD were not significantly different among the three radiologists: 0.876 (95% CI, 0.819-0.920) for radiologist 1, 0.883 (95% CI, 0.827-0.926) for radiologist 2, and 0.861 (95% CI, 0.801-0.908) for radiologist 3 (p > .05). The cutoff for the diagnosis of DTD was category III DTD-TIRADS. The sensitivity, specificity, and accuracy of DTD-TIRADS for detecting DTD were 86.5%, 81.1%, and 82.2% for radiologist 1; 86.5%, 83.2%, and 83.9% for radiologist 2; and 83.8%, 82.5%, and 82.8% for radiologist 3, respectively. Interobserver agreement of DTD-TIRADS categorization was almost perfect (κ = 0.81). CONCLUSION. DTD-TIRADS has high diagnostic performance and almost-perfect interobserver agreement. Thus, DTD-TIRADS can be considered to be an effective classification system for diagnosing DTD.

Shear wave elastography in diffuse thyroid disease

AIM

Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls.

METHODS

A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects.

RESULTS

Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis.

CONCLUSION

Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.

Thyroid Imaging Reporting and Data System for Detecting Diffuse Thyroid Disease on Ultrasonography: A Single-Center Study

Objective: This study aimed to compare the ultrasonography (US) features of diffuse thyroid disease (DTD) and normal thyroid parenchyma (NTP), and to propose a structured imaging reporting system for detecting DTD. Methods: This retrospective study assessed the findings for 270 consecutive patients who underwent thyroid US before thyroid surgery. The following US data were analyzed: DTD-specific features, parenchymal echotexture and echogenicity, anteroposterior diameter, glandular margin, and parenchymal vascularity. Univariate and multivariate analyses with generalized estimating equations were performed to investigate the relationship between US features and DTD. The fitted probability of DTD was analyzed by using a regression equation. Results: Of the 270 patients, there were NTP (n = 193), Hashimoto thyroiditis (n = 24), non-Hashimoto lymphocytic thyroiditis (n = 51), Graves' disease (n = 1), and diffuse hyperplasia (n = 1). The following US features were significantly associated with DTD: decreased or increased parenchymal echogenicity, coarse parenchymal echotexture, increased anteroposterior diameter, lobulated glandular margin, and increased parenchymal vascularity. Of these, coarse parenchymal echotexture was the most significant independent predictor of DTD. The numbers of abnormal US features were positively correlated with the fitted probability and risk of DTD. The diagnostic indices were highest when the chosen cut-off criterion was category III with the largest Az value (0.867, 95% confidence interval: 0.820-0.905), yielding a sensitivity of 68.8%, specificity of 92.2%, positive predictive value of 77.9%, negative predictive value of 88.1%, and accuracy of 85.6% (p < 0.001). Conclusions: Our sonographic reporting and data system may be useful for detecting DTD.

Diagnostic Accuracy of Real-Time Sonography in Differentiating Diffuse Thyroid Disease From Normal Thyroid Parenchyma: A Multicenter Study

OBJECTIVE

The purpose of this multicenter study was to assess the diagnostic accuracy of real-time sonography (US) for differentiating diffuse thyroid disease (DTD) from normal thyroid parenchyma among radiologists blinded to patients' clinical, serologic, and imaging history and to determine the differences in diagnostic accuracy among radiologists from different institutions.

MATERIALS AND METHODS

From January to March 2017, 214 patients underwent preoperative thyroid US and subsequent thyroid surgery at four participating institutions. Real-time US was performed at each institution by an attending radiologist, who classified US diagnoses into one of the following four categories based on US findings: no DTD, indeterminate, suspicious for DTD, and DTD. The outcomes of US diagnoses were compared with histopathologic results to determine the diagnostic accuracy of real-time US at each institution.

RESULTS

Histopathologic results included normal thyroid parenchyma (n = 143), Hashimoto thyroiditis (n = 29), non-Hashimoto lymphocytic thyroiditis (n = 37), and diffuse hyperplasia (n = 5). Normal thyroid parenchyma and DTD exhibited statistically significant differences in echogenicity, echotexture, size, glandular margin, vascularity of thyroid, and US classification. There was positive correlation between US classification and histopathologic results at all institutions for detecting DTD. The highest diagnostic indexes were obtained when the cutoff criterion was suspicious for DTD. There was favorable diagnostic accuracy, with statistically significant differences, at all institutions for the diagnosis of DTD.

CONCLUSION

Real-time US can be helpful for differentiating DTD from normal thyroid parenchyma.

Magnetic Resonance Imaging Features of Normal Thyroid Parenchyma and Incidental Diffuse Thyroid Disease: A Single-Center Study

Background: No previous studies have investigated the feasibility of magnetic resonance imaging (MRI) diagnosis for detecting incidental diffuse thyroid disease (DTD). This study investigated MRI features of normal thyroid parenchyma and incidental DTD. Methods: From January 2008 to December 2017, 387 patients underwent neck MRI in our hospital due to tumor/nodal staging (n = 137), lymphadenopathy (n = 122), inflammatory neck lesion (n = 85), congenital neck lesion (n = 12), and patient request (n = 31). Among them, 375 patients were excluded because of a lack of appropriate histopathological data on the thyroid parenchyma. Results: Among the patients included, 10 had normal thyroid parenchyma, 1 had Hashimoto thyroiditis, and 1 had diffuse hyperplasia. The common MRI features of normal thyroid parenchyma include iso-/slightly high and homogeneous signal intensity on T1/T2-weighted images, normal anteroposterior diameter of the thyroid gland, smooth margin, and homogeneously increased enhancement as compared to adjacent muscle. Hashimoto thyroiditis exhibited high and inhomogeneous signal intensity on T2-weighted images, while diffuse hyperplasia revealed an increased anteroposterior diameter and lobulated margin of the thyroid gland, and inhomogeneous enhancement. Conclusions: MRI may be helpful for detection of incidental DTD.

Diagnostic role of conventional ultrasonography and shearwave elastography in asymptomatic patients with diffuse thyroid disease: initial experience with 57 patients

PURPOSE

Thyroid ultrasonography (US) is a useful diagnostic tool in the evaluation of diffuse thyroid disease (DTD), whereas shearwave elastography is a dynamic technique that can provide information about tissue hardness by using acoustic shearwaves remotely induced by a focused ultrasonic beam. This study aims at investigating the role of conventional US and shearwave elastography in the diagnosis of asymptomatic patients with DTD.

MATERIALS AND METHODS

Fifty-seven patients who underwent both conventional US and shearwave elastography were included in this study. Interobserver variability of the three radiologists in assessment of underlying thyroid echogenicity on conventional US was analyzed. Diagnostic performances for diagnosing DTD on conventional US and shearwave elastography were calculated and compared.

RESULTS

Fair agreement was observed in the identification of DTD with conventional US (kappa value= 0.27). The area under the receiver operating characteristic curve (Az) were 0.52-0.585 on conventional US by three radiologists. The Az values when using the mean and maximum elasticity values as a diagnostic criteria for DTD were 0.619 and 0.59 on shearwave elastography. Patients with DTD showed higher mean [24.1±10 kilo-Pascals (kPa)] and maximum (36.4±13.3 kPa) elasticity values on shearwave elastography when compared to the normal group (23.4±10.8 kPa and 33.7±12.4 kPa, respectively), although without statistical significance (p=0.802 and p=0.452, respectively).

CONCLUSION

Conventional US did not show reliable interobserver agreement in the diagnosis of DTD. Although not statistically significant, shearwave elastography may provide additional information in the diagnosis of DTD. Therefore, larger prospective studies are needed to define the values of shearwave elastography for diagnosing DTD.