Journal of Endocrinological Investigation

, Volume 18, Issue 11, pp 857–861 | Cite as

Thyroid blood flow evaluation by color-flow doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis

  • Paolo Vitti
  • T. Rago
  • S. Mazzeo
  • S. Brogioni
  • M. Lampis
  • A. De Liperi
  • C. Bartolozzi
  • A. Pinchera
  • E. Martino
Article

Abstract

Thyroid hypoechogenicity at ultrasound is a characteristic of autoimmune thyroid diseases, with an overlap of this echographic pattern in patients affected by Graves’ disease or Hashimoto’s thyroiditis. Aim of the present paper was to study the thyroid blood flow (TBF) by color-flow doppler (CFD) and peak systolic velocity (PSV) at the inferior thyroid artery in 37 Graves’ and 45 goitrous Hashimoto’s thyroiditis patients. CFD pattern was defined as normal (or type 0): TBF limited to peripheral thyroid arteries (PSV = 17.7±3 cm/sec, mean±SD); type I: TBF mildly increased; type II: TBF clearly increased; type III: TBF markedly increased. The CFD was in direct relationship to the PSV. Out of 18 patients with Graves’ disease and untreated active hyperthyroidism CFD pattern was type III in 17 and type II in 1. The PSV was 42.1±15 cm/sec. In 17 patients euthyroid under methimazole, the CFD pattern was type 0 in 3 (17%) type I in 5 (30%), type II in 5 (30%), type III in 4 (23%). In this group of Graves’ patients the PSV was 36±14 cm/sec. In two patients, hypothyroid after radioiodine treatment, the CFD pattern was type 0 in 1 and type I in 1. In the group of Hashimoto’s patients TBF was in no relationship with thyroid status or treatment and was type 0 in 22 (49%), type I in 20 (44%), type II in 3 (7%), while none had type III CFD pattern. Thyroid hypoechogenicity at ultrasound was present in 32/37 (86%) Graves’ and 41/45 (91%) Hashimoto’s patients. All the four patients with Hashimoto’s thyroiditis and normal thyroid ultrasound pattern had also a normal CFD pattern, while 4/5 patients with Graves’ disease and normal echographic pattern had an increased TBF. In conclusion, a diffusely increased thyroid blood flow is pathognomonic of untreated Graves’ disease and an abnormal CFD pattern identifies the majority of Graves’ patients with a normal thyroid ultrasound pattern. Thus, CFD sonography may be useful in distinguishing patients with Graves’ disease and Hashimoto’s thyroiditis having a similar thyroid echographic pattern at ultrasound.

Key-words

Hypoechogenicity ultrasound pattern Hashimoto Graves’ thyroid blood flow autoimmune autoantibody 

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References

  1. 1.
    Volpé R. Autoimmune thyroiditis. In: Braverman L.E. Utiger R.D. (Eds.), The Thyroid. Lippincot Company Philadelphia. 1991, p. 921.Google Scholar
  2. 2.
    Amino N. Autoimmunity and hypothyroidism. J. Clin. Endocrinol. Metab. 2: 591, 1989.Google Scholar
  3. 3.
    Fisher D.A., Oddie T.H., Johnson D.E., Nelson J.C. The diagnosis of Hashimoto’s thyroiditis. J. Clin. Endocrinol. Metab. 40: 795, 1975.PubMedCrossRefGoogle Scholar
  4. 4.
    Mariotti S., Sansoni P., Barbesino G., Caturegli P., Monti D., Cossarizza A., Giacomelli T., Passeri G., Fagiolo U., Pinchera A. Thyroid and other organ-specific autoantibodies in healthy centenarians. Lancet 339: 1506, 1992.PubMedCrossRefGoogle Scholar
  5. 5.
    Gutekunst R., Hafferman W., Mansky T., Scriba P.C. Ultrasonography related to clinical and laboratory findings in lymphocitic thyroiditis. Acta Endocrinol. (Copenh.) 121: 129, 1981.Google Scholar
  6. 6.
    Espinasse P. L’ecographie thyroïdienne dans les thyroidites lymphocytaires chroniques autoimmunes. J Radiol. 64: 537, 1983.PubMedGoogle Scholar
  7. 7.
    Mueller H.W., Schroeder S., Schneider S.C., Seifert G. Sonographic tissue characterization in thyroid gland diagnosis. Klin. Wochenschr. 63: 706, 1985.CrossRefGoogle Scholar
  8. 8.
    Hayashi N., Tamaki N., Konishi J., Yonekura Y., Senda M., Kasagi K., Yamamoto K., Iida Y., Misaki T., Endo K. Sonography of Hashimoto’s Thyroiditis. J. Clin. Ultrasound. 14: 123, 1986.PubMedCrossRefGoogle Scholar
  9. 9.
    Marcocci C., Vitti P., Cetani F., Catalano F., Concetti R., Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocityc thyroiditis who are prone to develop hypothyroidism. J. Clin. Endocrinol. Metab. 72: 209, 1991.PubMedCrossRefGoogle Scholar
  10. 10.
    Vitti P., Lampis M., Piga M., Loviselli A., Brogioni S., Rago T., Pinchera A. Martino E. Diagnostic usefulness of thyroid ultrasonography in atrophie thyroiditis. J. Clin. Ultrasound. 22: 375, 1994.Google Scholar
  11. 11.
    Vitti P., Rago T., Mancusi F., Tonacchera M., Santini F., Chiovato L., Marcocci C., Pinchera A. Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves’ disease. Acta Endocrinol. (Copehn.) 126: 128, 1992.Google Scholar
  12. 12.
    Brunn J., Block U., Ruf G., Bos I., Kunze W.P., Scriba P.C. Volumetrie der Schildrusenlappen mittles Real-time Sonographie. Dtsch. Med. Wochenschr. 106: 1338, 1981.PubMedCrossRefGoogle Scholar
  13. 13.
    Leisner B. Ultrasound evaluation of thyroid disease. Horm Res. 26: 33, 1987.PubMedCrossRefGoogle Scholar
  14. 14.
    Rails P.W., Mayekawa D.S., Lee K.P., Coletti P.M., Radin V.R., Boswell W.D., Halls J.M. Color-flow doppler sonography in Graves’ disease: “thyroid inferno”. A.J.R. 150: 781, 1988.Google Scholar
  15. 15.
    Fobbe F., Finke R., Reichenstein E., Schleusener H., Wolf K-J. Appearance of thyroid diseases using colour-coded duplex sonography. Eur. J. Radiol. 9: 29, 1989.PubMedGoogle Scholar
  16. 16.
    Lagalla R., Caruso G., Romano M., Midiri M., Novara V., Zappasodi F. Eco-color-doppler nella patologia tiroidea. Radiologia Medica 85: 109, 1993.PubMedGoogle Scholar
  17. 17.
    Lagalla R., Caruso G., Novara V., Cardinale A.E. Analisi flussimetrica nelle malattie tiroidee: ipotesi di intregrazione con lo studio qualitativo con color-doppler. Radiologia Medica 85: 606, 1993.PubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 1995

Authors and Affiliations

  • Paolo Vitti
    • 1
  • T. Rago
    • 1
  • S. Mazzeo
    • 2
  • S. Brogioni
    • 1
  • M. Lampis
    • 3
  • A. De Liperi
    • 2
  • C. Bartolozzi
    • 2
  • A. Pinchera
    • 1
  • E. Martino
    • 1
  1. 1.Istituto di Endocrinologia, University of PisaPisaItaly
  2. 2.Istituto di Radiologia, University of PisaCagliariItaly
  3. 3.Divisione di MedicinaOspedale BrotzuCagliariItaly

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