Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome.

Castagnone, D; Rivolta, R; Rescalli, S.; Baldini, Marina; R, Tozzi; L, Cantalamessa

doi:10.2214/ajr.166.1.8571877

Cited by 91 publications

(51 citation statements)

References 16 publications

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“…In support of our results in thyroid arteries, an increased blood flow of the superior thyroid artery has been demonstrated in patients with Graves' disease, maintained in a euthyroid state with methimazole, prior to thyroid surgery (16). The increase in blood flow in the superior thyroid artery is positively correlated with microvessel density (17) and with vascular endothelial growth factor expression in hyperplasic follicular cells (18). These previous reports, together with the present results, indicate that vascularity in the thyroid gland does not parallel the methimazole-induced normalization of thyroid hormone levels, and that responsiveness of thyroid vessels does not follow the pattern of forearm resistance vessels.…”

Section: Discussionsupporting

confidence: 88%

Nitric oxide mediates abnormal responsiveness of thyroid arteries in methimazole-treated patients

Vila¹,

Mauricio²,

Segarra³

et al. 2005

eur j endocrinol

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Objective: We studied the intervention of nitric oxide (NO), prostacyclin and endothelium-derived hyperpolarizing factor (EDHF) in mediating responses to acetylcholine in thyroid arteries from euthyroid and methimazole-treated (MT) patients. Design and methods: Branches of the superior thyroid artery were obtained from 19 euthyroid patients and 17 MT patients (euthyroid at the time of surgery) undergoing total thyroidectomy or hemithyroidectomy. Artery rings were suspended in organ baths for isometric recording of tension. Results and conclusions: Acetylcholine caused endothelium-dependent relaxation of greater magnitude in arteries from MT patients (pD 2 (2log EC 50 ) values were 7.68^0.19 in euthyroid and 8.17^0.26 in MT patients, P , 0.05). The relaxation was unaffected by indomethacin and was partially reduced by the NO-synthase inhibitor NG-monomethyl-L-arginine (L-NMMA). This reduction was higher in arteries from MT patients (50^6%) as compared with euthyroid patients (36^6%) (P , 0.05). Inhibition of K þ channels using apamin combined with charybdotoxin or high K þ solution abolished the relaxation resistance to L-NMMA and indomethacin. The maximal contraction response to noradrenaline (as a percentage of the response to 100 mM KCl) was lower in MT than in euthyroid patients (57^10 and 96^8 respectively, P , 0.05). The hyporesponsiveness to noradrenaline in arteries from MT patients was corrected by L-NMMA. The results indicate that: (i) thyroid arteries from MT patients show an increased relaxation response to acethylcholine and a decreased contraction response to noradrenaline due to overproduction of NO; (ii) EDHF plays a prominent role in acetylcholine-induced relaxation through activation of Ca 2þ -activated K þ channels; (iii) the abnormal endothelium-dependent responses in arteries from MT patients are not corrected by medical treatment.European Journal of Endocrinology 152 551-556

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Section: Discussionsupporting

confidence: 88%

Nitric oxide mediates abnormal responsiveness of thyroid arteries in methimazole-treated patients

Vila¹,

Mauricio²,

Segarra³

et al. 2005

eur j endocrinol

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“…High intrathyroidal blood flow and an increase in mean peak systolic velocity (PSV) of the thyroid artery are wellknown signs of Graves' disease. 10 Thyroid vascularity can be used to predict the longterm course of Graves' disease while on medical therapy, 11 and disease outcome after withdrawal of antithyroid drugs. 10 Colour flow Doppler (CFD) ultrasonography can accurately differentiate between type 1 and type 2 amiodarone-induced thyrotoxicosis, and the results are generally in agreement with RAIU findings.…”

Section: Mean Sta-psv In Thyrotoxicosismentioning

confidence: 99%

“…10 Thyroid vascularity can be used to predict the longterm course of Graves' disease while on medical therapy, 11 and disease outcome after withdrawal of antithyroid drugs. 10 Colour flow Doppler (CFD) ultrasonography can accurately differentiate between type 1 and type 2 amiodarone-induced thyrotoxicosis, and the results are generally in agreement with RAIU findings. 9 Examination of CFD ultrasonography patterns is subjective, however, and it is difficult to quantify the findings.…”

Section: Mean Sta-psv In Thyrotoxicosismentioning

confidence: 99%

Mean Peak Systolic Velocity of the Superior Thyroid Artery is Correlated with Radioactive Iodine Uptake in Untreated Thyrotoxicosis

et al. 2012

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Bogazzi

Bartalena

Brogioni

et al. 1999

European Journal of Endocrinology

125

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Objective: Thyroid blood flow is greatly enhanced in untreated Graves' disease, but it is not known whether it is due to thyroid hormone excess or to thyroid hyperstimulation by TSH-receptor antibody. To address this issue in vivo patients with different thyroid disorders were submitted to color flow doppler sonography (CFDS). Subjects and methods:We investigated 24 normal subjects, and 78 patients with untreated hyperthyroidism (49 with Graves' hyperthyroidism, 24 with toxic adenoma, and 5 patients with TSH-secreting pituitary adenoma (TSHoma)), 19 patients with thyrotoxicosis (7 with thyrotoxicosis factitia, and 12 with subacute thyroiditis), 37 euthyroid patients with goitrous Hashimoto's thyroiditis, and 21 untreated hypothyroid patients with Hashimoto's thyroiditis. Results: Normal subjects had CFDS pattern 0 (absent or minimal intraparenchimal spots) and mean intraparenchimal peak systolic velocity (PSV) of 4.8 Ϯ 1.2 cm/s. Patients with spontaneous hyperthyroidism due to Graves' disease, TSHoma, and toxic adenoma had significantly increased PSV (P < 0.0001, P = 0.0004, P < 0.0001 respectively vs controls) and CFDS pattern. Patients with Graves' disease had CFDS pattern II (mild increase of color flow doppler signal) in 10 (20%) and pattern III (marked increase) in 39 cases (80%). Mean PSV was 15 Ϯ 3 cm/s. Patients with toxic adenoma had CFDS pattern I (presence of parenchymal blood flow with patchy uneven distribution) in 2 (8%), pattern II in 16 (70%) and pattern III in 5 (22%). Mean PSV was 11 Ϯ 2.4 cm/s. Patients with TSHoma showed CFDS pattern I in one case (20%) and pattern II in 4 (80%). Mean PSV was 14.8 Ϯ 4.2 cm/s. Patients with thyrotoxicosis had normal PSV (4.2 Ϯ 1.1 cm/s in subacute thyroiditis, 4 Ϯ 0.8 cm/s in thyrotoxicosis factitia, P = not significant vs controls) and CFDS pattern 0. Untreated euthyroid patients with goitrous Hashimoto's thyroiditis had CFDS pattern 0, and mean PSV (4.3 Ϯ 0.9 cm/s; P = not significant vs controls). Untreated hypothyroid patients with goitrous Hashimoto's thyroiditis had CFDS pattern I in 14 cases (67%), pattern II in 4 (19%) and pattern 0 in 3 (14%) and mean PSV (5.6 Ϯ 1.4 cm/s) was higher than that of controls (P = 0.026). Conclusions: An increase in both intrathyroidal vascularity and blood velocity was observed in patients with spontaneous hyperthyroidism but not in thyrotoxicosis due to either ingestion of thyroid hormones or to a thyroidal destructive process. The slightly increased vascularity and blood velocity observed in patients with hypothyroid Hashimoto's thyroiditis suggests that thyroid stimulation by either TSH-receptor antibody or TSH is responsible for the increased thyroid blood flow.

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Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome.

Cited by 91 publications

References 16 publications

Nitric oxide mediates abnormal responsiveness of thyroid arteries in methimazole-treated patients

Nitric oxide mediates abnormal responsiveness of thyroid arteries in methimazole-treated patients

Mean Peak Systolic Velocity of the Superior Thyroid Artery is Correlated with Radioactive Iodine Uptake in Untreated Thyrotoxicosis

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

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