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Color Doppler ultrasound and real-time elastography in patients with hypothyroidism for the prediction of levothyroxine replacement: a cross-sectional study of 338 patients

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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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Data availability

The data supporting this study's findings are available from the corresponding author, upon reasonable request.

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Funding

No funds, grants, or other support were received for conducting this study.

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Authors and Affiliations

  1. 2nd Academic Department of Nuclear Medicine, Faculty of Medicine, School of Health Sciences, AHEPA University Hospital, Venizelou 26, Kavala, 65403, Thessaloniki, Greece

    Nikolaos Angelopoulos & Ioannis Iakovou

  2. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Goulis

  3. Department of Radiology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Chrisogonidis

  4. Endocrine Unit, Athens Medical Centre, Athens, Greece

    Sarantis Livadas

Authors
  1. Nikolaos Angelopoulos
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  2. Dimitrios G. Goulis
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  3. Ioannis Chrisogonidis
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  4. Sarantis Livadas
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  5. Ioannis Iakovou
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by NA and SL. NA and DGG wrote the first draft of the manuscript and all authors commented on previous versions. NA, IC, DGG and II were responsible for the final version of the manuscript. Author II was responsible for the laboratory analysis of the data. All authors contributed to the experimental work. All authors read and approved the final manuscript.

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Correspondence to Nikolaos Angelopoulos.

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Ethical approval was obtained from the Bioethics Committee (Institutional Review Board) of the Aristotle University of Thessaloniki.

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Angelopoulos, N., Goulis, D.G., Chrisogonidis, I. et al. 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). https://doi.org/10.1007/s40477-024-00876-x

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