Lymphadenopathy in Autoimmune Thyroiditis: Paratracheal Lymph Nodes are Indeed Crucial

Abstract

Cervical lymphadenopathy is common in patients with autoimmune thyroiditis and supposed to be pathognomic for the disease if found in the paratracheal compartment (Robbins level VI). The aim of this prospective study is the extensive characterization of all cervical lymph node compartments in order to determine the significance of sonographic visible cervical lymphnodes in autoimmune thyroiditis. The study comprises 32 consecutive autoimmune thyroiditis patients and 32 controls without any thyroid pathologies. All patients underwent high resolution ultrasound and all visible lymph nodes were evaluated in all cervical levels by size, volume, S/L-ratio, appearance, vascularity and structural changes. In total, 84 lymph nodes in Robbins level VI were detected in the group of patients with autoimmune thyroiditis whereas the control group showed 2 positive lymph nodes. Lymph nodes in Robbins level VI were significantly smaller compared to lymph nodes in other cervical compartments with 54% of lymph nodes <5mm. Robbins level I-IV did not show any significant differences in the number of enlarged lymph nodes. S/L-ratio, vascularity and appearance was comparable in both groups in all cervical levels. In this prospective setting Robbins level VI could be identified as crucial lymph node level specific for autoimmune thyroiditis being pathognomic for the disease.