Peak Systolic Velocity of Superior Thyroid Artery for the Differential Diagnosis of Thyrotoxicosis

Abstract

AimThe differentiation of destruction-induced thyrotoxicosis and Graves’ disease (GD) is of great importance for selection of proper therapy. Radioactive iodine uptake (RAIU) is the gold standard for differentiating these two conditions but its application has remained somewhat limited. Thyroid color Doppler flow sonography (CDFS) is a potential alternative of RAIU but more supporting evidence is warranted. In the present study, a standard operative procedure was developed to measure the mean peak systolic velocity of superior thyroid artery (STA-PSV) and evaluate its role in the differential diagnosis of thyrotoxicosis.MethodsA total of 135 patients with untreated thyrotoxicosis were enrolled into one retrospective study (GD, n = 103; thyroiditis, n = 32) and another prospective study recruited 169 patients (GD, n = 118; thyroiditis, n = 51). Thirty normal controls were also enrolled. Thyroid function, anti-TSH-receptor antibody (TRAb), RAIU, CFDS of thyroid and STA-PSV were performed for each patient. Receiver operator curve (ROC) was used to evaluate the diagnostic value of STA-PSV in a retrospective study so as to seek the optimal cutoff point. Then the cutoff point value was used to validate its diagnostic value in a prospective study and in another thyrotoxicosis population.ResultsSTA-PSV of GD was significantly higher than that of thyroiditis in both retrospective and prospective studies. The area under the ROC curve of mean STA-PSV was 0.8799 and 0.9447 in the retrospective and prospective studies respectively. If a mean STA-PSV cutoff point of 50.5 cm/s was set from the retrospective analysis for the prospective study, the sensitivity and specificity in distinguishing GD from thyroiditis were 81.04% and 96.08% respectively. Mean STA-PSV and TRAb had similar area under ROC. The coefficients of variation in STA-PSV measurement were lower than 10% for the euthyroid, thyroiditis and GD groups.ConclusionsSTA-PSV is a feasible supplement alternative of RAIU for differentiating the causes of thyrotoxicosis.

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis

“…Studies have shown the presence of an exact intersection point in thyroid parenchymal blood supply distribution ranges in subjects with euthyroidism, thyroiditis and Graves disease 16. In our study, we showed the difference with superior and inferior thyroid artery EDV values with color Doppler US in subjects with normal vitamin D and HT.…”

Thyrotoxicosis associated with the use of amiodarone: the utility of ultrasound in patient management

“…In a hyperfunctioning thyroid gland, hypervascularity is observed, and CFDS has been used in the diagnosis of Graves' disease, solitary adenoma and toxic nodular goitre . Peak systolic velocity of the superior thyroid artery has been shown to accurately differentiate Graves' disease from thyroiditis . However, it has not been studied in AIT; hence, its usefulness in this context is speculative.…”

Role of Color Doppler Ultrasonography in Differentiation of Graves’ Disease from Thyroiditis: A Prospective Study

“…In most literatures, it has been observed that vascularity in GD decreased in parallel to the biochemical remission and clinical control, and that HRUSG with CD has the potential to monitor therapy response in patients, as well as distinguish GD patients from DT, with B-mode pattern, without the need for expensive laboratory assays in their studies. 9,14,15 Vitti et al 15 in their study demonstrated that the thyroid parenchymal blood flow can be correlated with the functional state of GD patients, being significantly increased in 17/18 patients with newly diagnosed active hyperthyroidism patients. In patients with DT, the thyroid blood flow did not correlate with the functional state of the gland.…”