Can Color Doppler Ultrasonography Differentiate Thyrotoxicoisis in Graves Disease from Subacute Thyroiditis?

Abstract Background Differentiating Graves’ disease from thyroiditis can be at times clinically challenging. The gold standard test (thyroid nuclear imaging scan) is expensive, not routinely available, and has radiation exposure. Color Doppler ultrasonography of thyroid represents a suitable alternate which can be used for differentiating these conditions by studying thyroid blood flow parameters. Aim We aimed to investigate the use of thyroid blood flow parameters’ assessment of the superior thyroid artery (STA) and common carotid artery (CCA) with color Doppler ultrasonography for differentiating Graves’ disease from thyroiditis. Materials and Methods This is a cross-sectional study on 111 patients with newly diagnosed thyrotoxicosis (82 with Graves’ disease and 29 with thyroiditis) and 45 years of age and sex-matched healthy controls. All patients underwent detailed clinical and necessary investigations. Color Doppler ultrasonography of the thyroid gland and spectral flow analysis of both superior thyroid arteries was done using standard protocol. Sensitivity and specificity for mean peak systolic velocity of STA (STA-PSV) cut-offs were calculated using receiver operating characteristic curves. Results Patients with Graves’ disease have significantly higher free tri-iodothyronine (FT3) levels, free thyroxine (FT4) levels, antithyroid stimulating hormone receptor antibody (TRAb) levels, and thyroid volume as compared with those with thyroiditis. The mean STA-PSV of patients with Graves’ disease was significantly higher than thyroiditis and control group. Mean STA-PSV greater than 54.3 cm/s had 82.9% sensitivity and 86.2% specificity in diagnosing Graves’ disease. Mean PSV-STA/PSV-CCA ratio of 0.40 was 80.5% sensitive and 86.2% specific for Graves’ disease. Conclusion Mean STA-PSV has high sensitivity and specificity in differentiating Graves’ disease from thyroiditis and can be used routinely in clinical practice as a cheap and invaluable diagnostic tool.

Download Full-text

Role of Color Doppler Ultrasonography in Differentiation of Graves’ Disease from Thyroiditis: A Prospective Study

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1208 ◽

2017 ◽

Vol 9 (2) ◽

pp. 41-45

Author(s):

Rv Suresh ◽

KS Thalavai Sundarram, ◽

Dhalapathy Sadacharan, ◽

Krishnan Ravikumar, ◽

S Kalpana,

Keyword(s):

Prospective Study ◽

Doppler Ultrasonography ◽

Color Doppler ◽

Cost Effective ◽

Color Doppler Ultrasonography ◽

Graves Disease ◽

Group I ◽

Group Ii ◽

A Prospective Study

ABSTRACT Introduction Thyrotoxicosis due to Graves’ disease (GD) and destructive thyroiditis (DT) needs differentiation, as management strategy differs. Factors that help in diagnosis are biochemical and nuclear imaging. Utility of high-resolution ultrasonography (HRUSG) and color Doppler (CD) in differentiation is not widely practiced. We undertook the prospective study in the Department of Endocrine Surgery at a tertiary care center among South Indian population in 1 year as a cost-effective model Materials and methods Out of 120 newly diagnosed thyrotoxicosis patients, 54 were GD (group I) and 66 were DT (group II) patients. Totally, 55 euthyroid patients served as controls. Parameters analyzed were demography, free thyroid function test (TFT) anti-thyroid-stimulating hormone receptor antibody (TSHrAB), antithyroid peroxidase antibody (ATPO), anti-thyroglobulin antibody (ATG), and Tc-99m thyroid scintigraphy. Parameters analyzed using HRUSG and CD were peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), resistive index (RI) of bilateral superior thyroid artery (STA) and inferior thyroid artery (ITA). Results Both groups were age and sex matched. The TFT, ATPO, and ATG were comparable between both groups (p = 0.609). The TSHrAB (IU/mL) was significantly higher in group I (36.11 ± 0.82) than group II (1.23 ± 0.24) (p < 0.001). Mean thyroid volume (mL) was higher in group I (28.9 ± 14.9) than group II (26.2 ± 8.81) (p = 0.022). Mean PSV-STA (cm/s) was statistically higher in group I (54.09 ± 4.67) than group II (28.92 ± 4.39) (p ≤ 0.001). Mean PSV-ITA (cm/s) was higher in group I (32.11 ± 2.45) than group II (25.23 ± 3.45) (p = 0.006). Other parameters measured in both arteries like mean EDV (cm/s), mean RI, and mean PI were comparable between both groups. Conclusion The HRUSG with CD evaluation of PSV STA and ITA is a cost-effective alternative to TSHrAB and thyroid scintigraphy in differentiating GD from DT patients. Additionally, we observed that PSV in STA was higher than in ITA in patients with GD. To conclude, HRUSG and CD are simple, cost-effective, and widely available tools in the differentiation of GD from DT. How to cite this article Sundarram KST, Sadacharan D, Ravikumar K, Kalpana S, Suresh RV. Role of Color Doppler Ultrasonography in Differentiation of Graves’ Disease from Thyroiditis: A Prospective Study. World J Endoc Surg 2017;9(2):41-45.

Download Full-text

Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves’ Disease

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200124121546 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1111-1124 ◽

Cited By ~ 1

Author(s):

Ruken Yuksekkaya ◽

Fatih Celikyay ◽

Serdar S. Gul ◽

Mehmet Yuksekkaya ◽

Faruk Kutluturk ◽

...

Keyword(s):

Blood Flow ◽

Diagnostic Performance ◽

Doppler Ultrasonography ◽

Color Doppler ◽

Autoimmune Disorder ◽

Color Doppler Ultrasonography ◽

Graves Disease ◽

Flow Parameters ◽

Positive Correlations ◽

Technetium Uptake

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.

Download Full-text