Color Doppler Sonography Patterns Related to Histological Findings in Graves' Disease

Abstract

The aim of this work was to correlate color duplex sonography (CDS) patterns and thyroid histology in hyperthyroid Graves' disease (GD) patients. Sixteen patients with relapsed GD were studied. Before starting a new cycle of medical therapy with methimazole in decreasing doses for 3 to 6 months (baseline study), the patients underwent functional, autoimmune, and CDS studies. The same studies were carried out again just before surgery (presurgical study) after medical therapy had produced a normalization of thyroid hormone serum levels. The thyroid glands were histologically examined and their patterns were compared with CDS patterns. Thirty-three normal subjects were used as a control group. At baseline, 6 patients (group I) had intraparenchymal homogeneous vascular color spots or diffusely distributed over the parenchyma lobe or in areas alternating with avascular zones (CDS-A pattern). In 8 patients (group II) the thyroid had vascular bands with avascular or poorly vascularized parenchymal areas (CDS-B pattern). In 2 patients, the 2 patterns were present in the same thyroid (A-B pattern or mixed pattern). In these 2 patients the histological aspects were more similar to the CDS-B pattern than the CDS-A pattern. The 2 groups of patients differed in the velocity of systolic peak (VP) that was significantly higher in group I than in group II. In the presurgical study, no changes relative to CDS patterns were observed in patient groups I and II. The VP did not show any appreciable modifications in either group of patients. The thyrotropin-stimulating antibodies (TRAb) returned to normal levels in group II, but not in group I. The 2 CDS patterns, observed in the baseline study, were histologically characterized either by a richly vascularized parenchyma with prevalent endothelial hyperplasia (parenchymatous goiter, CDS-A) or by fibrotic septation with prevalent vascular intimal hyperplasia (CDS-B). In conclusion, this CDS study in GD patients showed 2 distinct vascular patterns. The thyroid glands were histologically characterized by either a richly capillary vascularized parenchyma (parenchymatous goiter, CDS-A aspect) or by fibrotic septation with prevalent intraseptal arteriolar-like hyperplasia (fibrous goiter, CDS-B aspect). Such differences may be secondary to a different duration of hyperthyroidism and/or intensity of TRAb thyroid stimulation.

Real-time shear wave elastography may predict autoimmune thyroid disease

“…In addition, as a result of the immune process, the gland exhibits a pronounced lymphocytic infiltration and fibrosis [25][26][27]. As a result of all these changes, the goiter is usually firm, yet elastic, at palpation, and we would expect that the thyroid stiffness, measured by elastography, would be higher.…”

Measurement of Thyroid Blood Flow Area Is Useful for Diagnosing the Cause of Thyrotoxicosis

“…Increased blood flow and systolic velocity in either the thyroid artery or the thyroid tissue have been reported to be useful for differential diagnosis of thyrotoxicosis (1)(2)(3)(4)(5). However, the quantitative value of TBFA and the criteria by which CDU can distinguish between GD and DT have not yet been established because considerable overlap has been found between GD and DT.…”

Clinical experience of amiodarone‐induced thyrotoxicosis over a 3‐year period: role of colour‐flow Doppler sonography*

“…This distinction by blood flow is based on its use in the assessment of the related disease processes subacute thyroiditis and Graves’ disease (Baldini et al. , 1997; Morosini et al. , 1998; Hiromatsu et al.…”