Duplex Hemodynamic Parameters of Both Superior and Inferior Thyroid Arteries in Evaluation of Thyroid Hyperfunction Disorders

Abstract

Background Thyrotoxicosis may be caused by Graves’ disease or destructive thyroiditis. Differentiation between causes of thyrotoxicosis is crucial as management will differ. 99m Technetium (Tc)-pertechnetate thyroid scintigraphy is currently the gold standard for this purpose, however, is expensive and uses ionizing radiation. Objective To evaluate the role of color flow Doppler Ultrasound (CDU) of the superior thyroid (STA) and inferior thyroid arteries (ITA) as an inexpensive, non-invasive tool that can aid in differentiating between Graves’ disease and thyroiditis and compare it with thyroid scintigraphy. Methods Sixty-nine patients with newly-diagnosed thyrotoxicosis and 30 controls were enrolled. Thyroid functions, thyroid scintigraphy, and CDU of STA and ITA with measurements of peak systolic velocity (PSV) and end diastolic velocity (EDV), were performed. According to thyroid scintigraphy results, patients were divided into two groups: 42 patients with Graves’ disease and 27 patients with thyroiditis. Results PSV and EDV of both STA and ITA were significantly higher in patients with Graves’ disease than thyroiditis ( p -values <0.001). The STA-PSV had an equal sensitivity and specificity of 66.7%; cut-off value 76.57 cm/s, while those of STA-EDV were 73.8%, and 77.8% respectively; cut-off value 28.22 cm/s. ITA-PSV had a sensitivity and specificity of 76.2% and 77.8%, respectively; cut-off value 62.12 cm/s), while those of ITA-EDV were 78.6% and 77.8%, respectively; cut-off value 5.22 cm/s. Conclusion CDU parameters of the STA and ITA could be used as an alternative to thyroid scintigraphy for discriminating between Graves’ disease and thyroiditis.

A meta-analysis: elucidating diagnostic thresholds of peak systolic flow velocities in thyroid arteries for the discrimination of Graves’ disease and destructive thyrotoxicosis

“…The utilization of peak flow velocity measurements in either the superior or inferior thyroid artery has been previously posited as an effective diagnostic tool for thyrotoxicosis ( 5 , 35 ). This methodology has shown promise in distinguishing GD thyrotoxicosis from DT ( 4 , 10 , 15 ), as well as in monitoring the therapeutic response in GD patients post-radioactive iodine treatment ( 27 ). The value of STA-PSV has been equated to Radioactive Iodine Uptake (RAIU) in differentiating newly diagnosed thyroid toxicities ( 11 , 31 ).…”

“…demonstrated the efficacy of Doppler ultrasound in predicting the prognosis of GD and aiding in treatment strategy formulation ( 12 ). ITA-PSV has been proposed as a potential predictor of GD recurrence ( 13 , 14 ), and the flow characteristics in the superior and inferior thyroid arteries have been identified as valuable markers for distinguishing GD from thyroiditis ( 4 , 11 , 15 – 18 ). Recent advancements have further highlighted the diagnostic value of peak systolic flow velocity in thyroid arteries, as evidenced by Peng et al.’s investigation into the sensitivity and specificity of STA-PSV cut-off values ( 19 ).…”