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

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.

Type-1 response in peripheral CD4+ and CD8+ T cells from patients with Hashimoto's thyroiditis

“…The inclusion criteria were: (1) positivity for anti-thyroglobulin and/or anti-peroxidase antibodies (TgAb and TPOAb respectively) at high titres; (2) negativity for anti-TSH receptor antibodies (TRAb); (3) thyroid ultrasound imaging suggestive of a chronic thyroiditis (20); (4) no clinical history of hyperthyroidism; (5) no treatment with drugs known to induce thyroid autoimmunity and/or dysfunction (cytokines, lithium, amiodarone); (6) no pregnancy in the last 12 months prior to enrolment; and (7) non-smoker during the month prior to enrolment. The control group comprised 20 healthy subjects recruited from this establishment, matched for sex and age with the HT patients.…”

Thyroid vascularity and blood flow are not dependent on serum thyroid hormone levels: studies in vivo by color flow doppler sonography

“…The availability of color flow doppler sonography (CFDS), a rapid, informative, and non-invasive technique, has recently allowed direct measurement of intrathyroidal blood flow (10)(11)(12)(13)(14)(15)(16)(17). Using CFDS it has been shown that intrathyroidal blood flow, which can be quantitated by measurement of peak systolic velocity (PSV), is greatly increased in patients with untreated Graves' hyperthyroidism (10,11).…”

Prognostic value of vascularity index for the diagnosis of autoimmune thyroid disease

“…Several qualitatively classifications of intrathyroidal vascular patterns distinctive to specific pathological entities have been proposed, with that of Vitti's being the most widely used in clinical practice (9). This classification describes easily and quickly the intraparenchymal of thyroid autoimmunity, and to compare its sensitivity and specificity with other gray-scale sonographic findings.…”