Does Normal Thyroid Gland by Ultrasonography match with Normal Serum Thyroid Hormones and Negative Thyroid Antibodies?

Trimboli, Pierpaolo; Rossi, Fábio; Condorelli, Emma; Laurenti, O.; Ventura, Claudio; Nigri, Giuseppe; Romanelli, Francesco; Guarino, M; Valabrega, Stefano

doi:10.1055/s-0029-1237700

Cited by 12 publications

(9 citation statements)

References 5 publications

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“…In this context, a recent paper raised the question of whether normal thyroid echostructure and echogenicity matched with normal laboratory assessment. The results showed that 75% of cases had normal thyroid hormones and negative T-Ab [5]. While the latter represented an instantaneous picture of laboratory assessment in a small high selected series of subjects with normal thyroid at ultrasound, here we analysed a large casuistry, re-evaluating after one year the subjects with skewed laboratory tests.…”

Section: Comparison Between Normal and Pathologic Ultrasonographymentioning

confidence: 94%

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One in five subjects with normal thyroid ultrasonography has altered thyroid tests

et al. 2012

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The relation between thyroid ultrasonography and laboratory, and the relationship of thyroid volume with clinical and anthropometric parameters, are not well clarified. Aim of the study was to investigate normal and hypoechoic-inhomogeneous not nodular thyroid gland in predicting thyroid tests, and to assess the correlation of thyroid volume with several clinical parameters. The series included 434 subjects (244 with normal thyroid ultrasonography, and 190 with hypoechoic-inhomogeneous thyroid) at their first evaluation. Subjects with normal ultrasonography and skewed tests were re-evaluated after one year. All subjects with normal ultrasound showed normal free-T-4, while TSH was elevated in 9.8% of cases and thyroid antibodies were positive in another 9.8%. In patients with hypoechoic-inhomogeneous thyroid, free-T-4 was low in 33.2%, TSH was elevated in 78.4% and thyroid antibodies were positive in 76.3%. Normal ultrasonography matched with normal tests in 81.1% of cases while hypoechoic-inhomogeneous thyroid in 9.5% (p<0.001). The re-evaluation of tests showed no significant difference. In subjects with both normal ultrasonography and tests, thyroid volume was correlated with age (p=0.001), weight (p=0.003), BMI (p=0.04), body surface area (p=0.002). Thyroid laboratory assessment was different between subjects with ultrasonographically normal or hypoechoic-inhomogeneous thyroid. Thyroid volume of thyroid diseases-free subjects was correlated with age, weight, BM I and body surface area, and this should be of interest to investigate the references of normality of thyroid size

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Section: Comparison Between Normal and Pathologic Ultrasonographymentioning

confidence: 94%

“…Moreover, a recent paper showed that normal US matched with normal thyroid tests frequently in a small series of highly selected subjects [5].…”

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confidence: 97%

One in five subjects with normal thyroid ultrasonography has altered thyroid tests

et al. 2012

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“…Two expert examiners (PT, MFT) performed US using an Esaote MyLab system (Esaote, Genova, Italy) equipped with linear probe working at 8-14 MHz. The inter-observer variability for these investigators was 8.2 % [11,12]. To evaluate gland echogenicity and homogeneity, clips and freeze images for all patients were stored and blindly reviewed by the two investigators.…”

Section: Thyroid Ultrasound Evaluationmentioning

confidence: 99%

“…These papers report that hypoechogenicity of the thyroid gland represents a risk factor for developing hypothyroidism over time [7][8][9][10]. Also, at least 80 % of subjects with normal thyroid (NT) US pattern have NT function [11,12]. To recap, US examination is characterized by poor reproducibility due to high intra-and inter-observer variability [13,14].…”

Section: Introductionmentioning

confidence: 99%

Analysis of tissue surrounding thyroid nodules by ultrasound digital images

Trimboli

Bini

Andrioli³

et al. 2014

Endocrine

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Since US is not easily reproducible, the digital image analysis (IA) has been proposed so that the image evaluation is not subjective. In fact, IA meets the criteria of objectivity, accurateness, and reproducibility by a matrix of pixels whose value is displayed in a gray level. This study aims at evaluating via IA the tissue surrounding a thyroid nodule (backyard tissue, BT) from goitres with benign (b-BT) and malignant (m-BT) lesions. Sixty-nine US images of thyroid nodules surrounded by adequate thyroid tissue was classified as normoechoic and homogeneous were enrolled as study group. Forty-three US images from normal thyroid (NT) glands were included as controls. Digital images of 800 × 652 pixels were acquired at a resolution of eight bits with a 256 gray levels depth. By one-way ANOVA, the 43 NT glands were not statistically different (P = 0.91). Mean gray level of normal glands was significantly higher than b-BT (P = 0.026), and m-BT (P = 0.0001), while no difference was found between b-BT and m-BT (P = 0.321). NT tissue boundary external to the nodule was found at 6.0 ± 0.5 mm in cancers and 4.0 ± 0.5 mm in benignancies (P = 0.001). These data should indicate that the tissue surrounding a thyroid nodule may be damaged even when assessed as normal by US. This is of interest to investigate the extranodular effects of thyroid tumors.

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“…There are patients with undetectable thyroid antibodies who may have a thyroiditis pattern on ultrasound (19,20). Furthermore, population studies in non-pregnant women confirm that upper reference range of TSH is reduced after excluding those with ultrasound patterns compatible with thyroiditis (20)(21)(22). International guidelines recommend populations with adequate iodine intake to be used to define TSH reference ranges.…”

Section: Introductionmentioning

confidence: 98%

Recent recommendations from ATA guidelines to define the upper reference range for serum TSH in the first trimester match reference ranges for pregnant women in Rio de Janeiro

Morais¹,

Assis²,

Corcino³

et al. 2018

Archives of Endocrinology and Metabolism

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Objectives: American Thyroid Association (ATA)'s new guidelines recommend use of populationbased trimester-specific reference range (RR) for thyrotropin (TSH) in pregnancy. The aim of this study was to determine first trimester TSH RR for a population of pregnant women in Rio de Janeiro State. Subjects and methods: Two hundred and seventy pregnant women without thyroid illness, defined by National Academy of Clinical Biochemistry, and normal iodine status were included in this sectional study. This reference group (RG) had normal median urinary iodine concentration (UIC = 219 μg/L) and negative anti-thyroperoxidase antibodies (TPOAb). Twin pregnancy, trophoblastic disease and use of drugs or supplements that influence thyroid function were excluded. In a second step, we defined a more selective reference group (SRG, n = 170) by excluding patients with thyroiditis pattern on thyroid ultrasound and positive anti-thyroglobulin antibodies. This group also had normal median UIC. At a final step, a more selective reference group (MSRG, n = 130) was defined by excluding any pregnant women with UIC < 150 µg/L. Results: In the RG, median, 2.5 th and 97.5 th percentiles of TSH were 1.3, 0.1, and 4.4 mIU/L, respectively. The mean age was 27.0 ± 5.0 and the mean body mass index was 25.6 ± 5.2 kg/m 2. In the SRG and MSRG, 2.5 th and 97.5 th percentiles were 0.06 and 4.0 (SRG) and 0.1 and 3.6 mIU/L (MSRG), respectively. Conclusions: In the population studied, TSH upper limit in the first trimester of pregnancy was above 2.5 mIU/L. The value of 3.6 mIU/L, found when iodine deficiency and thyroiditis (defined by antibodies and ultrasound characteristics) were excluded, matches recent ATA guidelines.

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Does Normal Thyroid Gland by Ultrasonography match with Normal Serum Thyroid Hormones and Negative Thyroid Antibodies?

Cited by 12 publications

References 5 publications

One in five subjects with normal thyroid ultrasonography has altered thyroid tests

One in five subjects with normal thyroid ultrasonography has altered thyroid tests

Analysis of tissue surrounding thyroid nodules by ultrasound digital images

Recent recommendations from ATA guidelines to define the upper reference range for serum TSH in the first trimester match reference ranges for pregnant women in Rio de Janeiro

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