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Thyroid Ultrasonography in Medical Imaging Re-
1
Keywords
Hashimoto’s thyroiditis, Graves’ disease, thyroid sonography
Introduction
G
raves’ disease and Hashimoto’s thyroiditis are two common au- *Corresponding author:
to-immune diseases of thyroid gland. Hashimoto’s thyroiditis or G. R. Pishdad, MD
chronic lymphocytic thyroiditis is the most common cause of Endocrine & Metabolism
Research Center
goiter in regions with no iodine deficiency. In this disease the thyroid Shiraz University of
gland is gradually destroyed by cell and antibody mediated immune pro- Medical Sciences
cess. Graves’ disease is the most common cause of hyperthyroidism [1]. Shiraz, Iran
E-mail: pishdadg@sums.
Due to limitations in physical examination of the thyroid gland and re- ac.ir
cent advances in sonographic technology, nowadays, ultrasonography is Received: 12 April 2016
being increasingly used to assist in the diagnosis of thyroid diseases [2]. Accepted: 10 July 2016
Table 2: Number and percentage of positive and negative antibody in each group.
Graves’ disease. Alternatively, it can be said been declared that there is no significant cor-
83.3% of patients with peripheral hypoecho- relation between thyroid echogenicity and se-
genicity were in Hashimoto’s thyroiditis group rum anti-Tpo titers [5], but Zheng et al deter-
and 60% of central hypoechoic patterns were mined that patients with thyroid parenchymal
in Graves’ group (Table. 4). low echogenicity have a more chance of being
The most common pattern of echogenicity positive for anti-Tpo and anti Tg [6]. As seen
control group was homogeneous isoecho- in Table 2, in our study Hashimoto’s group pa-
genicity which was observed in 49.1% of tients selected had positive anti-Tpo and anti
cases. The next pattern was homogeneous hy- Tg.
perechogenicity that was seen in 41.5% of the As depicted in to Table 3, the frequency of
cases (Table 4). nodularity in our study was 28.18% which is
Homogeneous hypoechogenicity in Hashi- close to the findings of Anderson et al. They
moto’s thyroiditis had a specificity and sen- detected a single nodule in 36% of their Hashi-
sitivity of 90.6% and 45.2%, respectively. In moto’s cases. 84% of their Hashimoto’s nod-
case of patients in Graves’ disease the above ules were benign (13, 14). Some other studies
percentage were 90.6% and 47.1%, respec- reported nodularity of 42% [4].
tively (Table 5). In this study different echogenity patterns
Peripheral hypoechogenicity in Hashi- including peripheral and central hypoecho-
moto’s thyroiditis had 100% specificity and genicity were evaluated. To the best of our
40.3 % sensitivity. Central Hypoechogenicity knowledge presence of these patterns has not
in Graves’ disease had 100% specificity and been evaluated in previous studies in the diag-
17.6% sensitivity (Table. 5). nosis and/or differentiation of Graves’ disease
and Hashimoto’s thyroiditis.
Discussion As seen in Table 4, the most common so-
Although in some previous studies it has nographic pattern in our patients with Hashi-
Hashimoto’s
Sensitivity
Specificity
Sensitivity
Specificity
Graves’ disease
Sonographic thyroiditis
pattern
- + - +
homogenously - 48 34 48 18
45.2% 90.6% 47.1% 90.6%
hypoechoic + 5 28 5 16
peripherally - 53 37 53 29
40.3% 100% 14.7% 100%
hypoechoic + 0 25 0 5
centrally hy- - 53 58 53 28
6.5% 100% 17.6% 100%
poechoic + 0 4 0 6
homogenously - 27 57 27 32
8.1% 50.9% 5.9% 50.9%
isoechoic + 26 5 26 2
homogenously - 31 62 31 29
0% 58.5% 14.7% 58.5%
hyperechoic 0 22 22 5