Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves’ Disease

Author(s): Ruken Yuksekkaya*, Fatih Celikyay, Serdar S. Gul, Mehmet Yuksekkaya, Faruk Kutluturk and Cansel Ozmen

Volume 16, Issue 9, 2020

Page: [1111 - 1124] Pages: 14

DOI: 10.2174/1573405616666200124121546

Price: $65

Abstract

Background: Graves’ Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive.

Objectives: To investigate the thyroid blood flow in patients with Graves’ Disease by color Doppler Ultrasonography and a newly developed software Color Quantification.

Methods: Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated.

Results: The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all).

Conclusion: The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves’ Disease.

Keywords: Graves disease, color doppler ultrasonography, Technetium (99mTc) pertechnetate thyroid scintigraphy, autoimmune disorder, thyroid hormones, thyrotropin.

Graphical Abstract

[1]
Ross DS, Burch HB, Cooper DS, et al. 2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26(10): 1343-421.
[http://dx.doi.org/10.1089/thy.2016.0229] [PMID: 27521067]
[2]
Tibaldi JM, Barzel US, Albin J, Surks M. Thyrotoxicosis in the very old. Am J Med 1986; 81(4): 619-22.
[http://dx.doi.org/10.1016/0002-9343(86)90547-4] [PMID: 3766592]
[3]
Davis PJ, Davis FB. Hyperthyroidism in patients over the age of 60 years. Clinical features in 85 patients. Medicine (Baltimore) 1974; 53(3): 161-81.
[http://dx.doi.org/10.1097/00005792-197405000-00001] [PMID: 4133091]
[4]
Brent GA. Clinical practice. Graves’ disease. N Engl J Med 2008; 358(24): 2594-605.
[http://dx.doi.org/10.1056/NEJMcp0801880] [PMID: 18550875]
[5]
Bartalena L. Diagnosis and management of Graves disease: A global overview. Nat Rev Endocrinol 2013; 9(12): 724-34.
[http://dx.doi.org/10.1038/nrendo.2013.193] [PMID: 24126481]
[6]
Morosini PP, Simonella G, Mancini V, et al. Color doppler sonography patterns related to histological findings in Graves’ disease. Thyroid 1998; 8(7): 577-82.
[http://dx.doi.org/10.1089/thy.1998.8.577] [PMID: 9709910]
[7]
Kumar KV, Vamsikrishna P, Verma A, Muthukrishnan J, Rayudu BR, Modi KD. Utility of colour Doppler sonography in patients with Graves’ disease. West Indian Med J 2009; 58(6): 566-70.
[PMID: 20583684]
[8]
Arslan H, Unal O, Algün E, Harman M, Sakarya ME. Power Doppler sonography in the diagnosis of Graves’ disease. Eur J Ultrasound 2000; 11(2): 117-22.
[http://dx.doi.org/10.1016/S0929-8266(99)00079-8] [PMID: 10781659]
[9]
Zhao X, Chen L, Li L, et al. Peak systolic velocity of superior thyroid artery for the differential diagnosis of thyrotoxicosis. PLoS One 2012; 7(11)e50051
[http://dx.doi.org/10.1371/journal.pone.0050051] [PMID: 23166817]
[10]
Akhter AA, Fariduddin M. Can Color Doppler Ultrasonography Differentiate Thyrotoxicoisis in Graves’ Disease from Subacute Thyroiditis. J Endocrinol Thyroid Res 2017; 2(5)555600
[11]
Donkol RH, Nada AM, Boughattas S. Role of color Doppler in differentiation of Graves’ disease and thyroiditis in thyrotoxicosis. World J Radiol 2013; 5(4): 178-83.
[http://dx.doi.org/10.4329/wjr.v5.i4.178] [PMID: 23671754]
[12]
Hiraiwa T, Tsujimoto N, Tanimoto K, Terasaki J, Amino N, Hanafusa T. Use of color Doppler ultrasonography to measure thyroid blood flow and differentiate graves’ disease from painless thyroiditis. Eur Thyroid J 2013; 2(2): 120-6.
[http://dx.doi.org/10.1159/000350560] [PMID: 24783050]
[13]
Alnaqdy A, Al-Maskari M. Determination of the levels of anti-thyroid-stimulating hormone receptor antibody with thyroid peroxidase antibody in Omani patients with Graves’ disease. Med Princ Pract 2005; 14(4): 209-12.
[http://dx.doi.org/10.1159/000085736] [PMID: 15961927]
[14]
Beever K, Bradbury J, Phillips D, et al. Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase. Clin Chem 1989; 35(9): 1949-54.
[PMID: 2776323]
[15]
Ilicki A, Gamstedt A, Karlsson FA. Hyperthyroid Graves’ disease without detectable thyrotropin receptor antibodies. J Clin Endocrinol Metab 1992; 74(5): 1090-4.
[PMID: 1349025]
[16]
Prasek K, Płazińska MT, Królicki L. Diagnosis and treatment of Graves’ disease with particular emphasis on appropriate techniques in nuclear medicine. General state of knowledge. Nucl Med Rev Cent East Eur 2015; 18(2): 110-6.
[http://dx.doi.org/10.5603/NMR.2015.0026] [PMID: 26315874]
[17]
Dige-Petersen H, Kroon S, Vadstrup S, Andersen ML, Roy-Poulsen NO. A comparison of 99Tc and 123I scintigraphy in nodular thyroid disorders. Eur J Nucl Med 1978; 3(1): 1-4.
[http://dx.doi.org/10.1007/BF00253469] [PMID: 753616]
[18]
Ikekubo K, Hino M, Ito H, et al. Thyrotoxic Graves’ disease with normal thyroidal technetium-99m pertechnetate uptake. Ann Nucl Med 1990; 4(2): 43-8.
[http://dx.doi.org/10.1007/BF03164594] [PMID: 2171608]
[19]
Vitti P. Grey scale thyroid ultrasonography in the evaluation of patients with Graves’ disease. Eur J Endocrinol 2000; 142(1): 22-4.
[http://dx.doi.org/10.1530/eje.0.1420022] [PMID: 10633216]
[20]
Espinasse P. L’échographie thyroïdienne dans les thyroïdites lymphocytaires chroniques autoimmunes. J Radiol 1983; 64(10): 537-44.
[PMID: 6689341]
[21]
Gutekunst R, Hafermann W, Mansky T, Scriba PC. Ultrasonography related to clinical and laboratory findings in lymphocytic thyroiditis. Acta Endocrinol (Copenh) 1989; 121(1): 129-35.
[http://dx.doi.org/10.1530/acta.0.1210129] [PMID: 2662693]
[22]
Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R, Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. J Clin Endocrinol Metab 1991; 72(1): 209-13.
[http://dx.doi.org/10.1210/jcem-72-1-209] [PMID: 1986019]
[23]
Pishdad P, Pishdad GR, Tavanaa S, Pishdad R, Jalli R. Thyroid ultrasonography in differentiation between Graves’ disease and Hashimoto’s Thyroiditis. J Biomed Phys Eng 2017; 7(1): 21-6.
[PMID: 28451576]
[24]
Wang Y, Ruan Z, Zhang J, et al. Hashimoto’s thyroiditis shows characteristics of increased thyroid volume, decreased echo and increased blood flow signals using ultrasound gray-scale intensity technology. Biomed Res (Aligarh) 2017; 28(14): 6365-70.
[25]
dos Santos TARR, Pina ROG, de Sauza MTP, Chammas MC. Graves’ Disease thyroid color-flow Doppler ultrasonography assessment: Review article. Health 2014; 6: 1487-96.
[http://dx.doi.org/10.4236/health.2014.612183]
[26]
Chiou SC, Peng YS, Chen PY, et al. Color Doppler ultrasonography of inferior thyroid artery and its relation with thyroid functional state. Med Ultrasound 2006; 14(3): 51-7.
[http://dx.doi.org/10.1016/S0929-6441(09)60091-6]
[27]
Ota H, Amino N, Morita S, et al. Quantitative measurement of thyroid blood flow for differentiation of painless thyroiditis from Graves’ disease. Clin Endocrinol (Oxf) 2007; 67(1): 41-5.
[http://dx.doi.org/10.1111/j.1365-2265.2007.02832.x] [PMID: 17437515]
[28]
Androulakis AE, Labropoulos N, Allan R, Tyllis TK, al-Kutoubi A, Nicolaides AN. The role of common carotid artery end-diastolic velocity in near total or total internal carotid artery occlusion. Eur J Vasc Endovasc Surg 1996; 11(2): 140-7.
[http://dx.doi.org/10.1016/S1078-5884(96)80042-6] [PMID: 8616643]
[29]
Bianchini Höfling D, Marui S, Buchpiguel CA, Cerri GG, Chammas MC. The end-diastolic velocity of thyroid arteries is strongly correlated with the peak systolic velocity and gland volume in patients with autoimmune thyroiditis. J Thyroid Res 2017.20171924974
[http://dx.doi.org/10.1155/2017/1924974] [PMID: 29062583]
[30]
Kurita S, Sakurai M, Kita Y, et al. Measurement of thyroid blood flow area is useful for diagnosing the cause of thyrotoxicosis. Thyroid 2005; 15(11): 1249-52.
[http://dx.doi.org/10.1089/thy.2005.15.1249] [PMID: 16356088]
[31]
Cappelli C, Pirola I, De Martino E, et al. The role of imaging in Graves’ disease: A cost-effectiveness analysis. Eur J Radiol 2008; 65(1): 99-103.
[http://dx.doi.org/10.1016/j.ejrad.2007.03.015] [PMID: 17459638]
[32]
Yamashiro I, de Cassio Saito O, Chammas CC, Cerri GG. Ultrasound findings in thyroiditis. Radiol Bras 2007; 40(2): 75-9.
[http://dx.doi.org/10.1590/S0100-39842007000200003]
[33]
Schiemann U, Gellner R, Riemann B, et al. Standardized grey scale ultrasonography in Graves’ disease: correlation to autoimmune activity. Eur J Endocrinol 1999; 141(4): 332-6.
[http://dx.doi.org/10.1530/eje.0.1410332] [PMID: 10526244]
[34]
Vitti P, Rago T, Mancusi F, et al. Thyroid hypoechogenic pattern at ultrasonography as a tool for predicting recurrence of hyperthyroidism after medical treatment in patients with Graves’ disease. Acta Endocrinol (Copenh) 1992; 126(2): 128-31.
[http://dx.doi.org/10.1530/acta.0.1260128] [PMID: 1543017]
[35]
Vitti P, Rago T, Mazzeo S, et al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves' disease from Hashimoto's thyroiditis. J Endocrinol lnvest 1995; 18(11): 857-61..
[36]
Höfling DB, Cerri G, Juliano A, Marui S, Chammas MC. B value of thyroid echogenicity in the diagnosis of Chronic Autoimmune Thyroiditis. Radiol Bras 2008; 41: 409-17.
[37]
Sayki Arslan M, Sahin M, Topaloglu O, et al. Hyperprolactinaemia associated with increased thyroid volume and autoimmune thyroiditis in patients with prolactinoma. Clin Endocrinol (Oxf) 2013; 79(6): 882-6.
[http://dx.doi.org/10.1111/cen.12217] [PMID: 23551036]
[38]
Rotondi M, de Martinis L, Coperchini F, et al. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto’s thyroiditis. Eur J Endocrinol 2014; 171(1): 31-6.
[http://dx.doi.org/10.1530/EJE-14-0147] [PMID: 24743395]
[39]
Nduka CC, Adeyekun AA. Ultrasound assessment of thyroid gland volume in diabetic patients without overt thyroid disease. Ann Afr Med 2016; 15(4): 157-62.
[http://dx.doi.org/10.4103/1596-3519.194276] [PMID: 27853029]
[40]
Georgiadis E, Papapostolou C, Korakis T, Evagelopoulou K, Mantzoros C, Batrinos M. The influence of smoking habits on thyroid gland volume: An ultrasonic approach. J R Soc Health 1997; 117(6): 355-8.
[http://dx.doi.org/10.1177/146642409711700605] [PMID: 9519672]
[41]
Hegedüs L, Hansen JM, Karstrup S. High incidence of normal thyroid gland volume in patients with Graves’ disease. Clin Endocrinol (Oxf) 1983; 19(5): 603-7.
[http://dx.doi.org/10.1111/j.1365-2265.1983.tb00037.x] [PMID: 6688972]
[42]
Solbiati L, Livratti T, Ballariti E, Ierace T, Crespi L. Thyroid Gland ultrasound of superficial structures-high frequencies, Doppler and interventional procedures. New York: Churchill Livingstone 1995; pp. 49-85.
[43]
Dobyns BM, Sheline GE, Workman JB, Tompkins EA, McConahey WM, Becker DV. Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: A report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab 1974; 38(6): 976-98.
[http://dx.doi.org/10.1210/jcem-38-6-976] [PMID: 4134013]
[44]
Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: Classification, characterization, and response to treatment. Thyroid 1998; 8(7): 571-6.
[http://dx.doi.org/10.1089/thy.1998.8.571] [PMID: 9709909]
[45]
Cantalamessa L, Baldini M, Orsatti A, Meroni L, Amodei V, Castagnone D. Thyroid nodules in Graves disease and the risk of thyroid carcinoma. Arch Intern Med 1999; 159(15): 1705-8.
[http://dx.doi.org/10.1001/archinte.159.15.1705] [PMID: 10448772]
[46]
Caruso G, Attard M, Caronia A, Lagalla R. Color Doppler measurement of blood flow in the inferior thyroid artery in patients with autoimmune thyroid diseases. Eur J Radiol 2000; 36(1): 5-10.
[http://dx.doi.org/10.1016/S0720-048X(00)00147-9] [PMID: 10996751]
[47]
Banaka I, Thomas D, Kaltsas G. Value of the left inferior thyroid artery peak systolic velocity in diagnosing autoimmune thyroid disease. J Ultrasound Med 2013; 32(11): 1969-78.
[http://dx.doi.org/10.7863/ultra.32.11.1969] [PMID: 24154901]
[48]
Bogazzi F, Bartalena L, Brogioni S, et al. Thyroid vascularity and blood flow are not dependent on serum thyroid hormone levels: Studies in vivo by color flow Doppler sonography. Eur J Endocrinol 1999; 140(5): 452-6.
[http://dx.doi.org/10.1530/eje.0.1400452] [PMID: 10229913]
[49]
Sarikaya B, Demirbilek H, Akata D, Kandemir N. The role of the resistive index in Hashimoto’s thyroiditis: A sonographic pilot study in children. Clinics (São Paulo) 2012; 67(11): 1253-7.
[http://dx.doi.org/10.6061/clinics/2012(11)05] [PMID: 23184199]
[50]
Lin GS, Spratt RS. Hemodynamic imaging with pulsatility-index and resistive-index color Doppler US. Radiology 1997; 204(3): 870-3.
[http://dx.doi.org/10.1148/radiology.204.3.9280274] [PMID: 9280274]
[51]
Wang CY, Chang TC. Thyroid Doppler ultrasonography and resistive index in the evaluation of the need for ablative or antithyroid drug therapy in Graves’ hyperthyroidism. J Formos Med Assoc 2001; 100(11): 753-7.
[PMID: 11802534]

Rights & Permissions Print Cite
Article Metrics
20
1
© 2024 Bentham Science Publishers | Privacy Policy