| purposeIn order to characterize high-frequency sonographic appearance due to Hashimoto’s Thyroiditis(HT) with hypothyroidism and Doppler of blood flow and to find and diagnose at early stage, reducing the missed diagnosis rate and diagnostic error rate.MethodologySelect sample of194patients with Hashimoto’s Thyroiditis during period Jan2013-Mar2014and diagnosed with HT by clinic and high frequency ultrasound with strong positive of thyroid peroxidase antibody (TPOAb) and or thyroglobulin antibody(TGAb). Using the Germany Siemens Sequoia-512type ultrasound diagnostic instrument, Conventional examinate bilateral thyroid lobes and isthmus, measure thyroid size and observe shape, internal echoes and state of color blood Doppler, using pulse Doppler to measure Doppler frequency of superior thyroid artery as well. Next day endocrine check was conducted. Results were grouped to A (HT normal,n=47),B(HT Hashitoxicosis, n=25),C(HT subclinical hypothyroidism,n=46),D(HT Clinical hypothyroidism,n=43), which all above group had short course of disease with HT(<3months) and never had treatment with HT. E(post-treatment group,n=33) according to thyroid function. Group E with the late course HT (course of disease>2years) and Clinical therapy history (>1years) treated with Levothyroxine. Control group with45health adults. All patients of each group need to exclude secondary hypothyroidism, or adrenal disease and chronic liver disease caused by hypothyroidism. Adopt a retrospective analysis and comparison of sonographic appearance and blood flow Doppler across all these groups.Statistical analysis was conducted using SPSS11.5. All Statistics are presented with mean standard deviation. T-test is used compare two groups and F-test for multiple groups. We deem test as statistically significant ifp-value<.05.Results1The length, width, thickness of thyroidComparing group A,B,C,D with control group, there are significant differences in length, width and thickness (p-value<.05), specifically p-value of thickness differences is less than.01,while there are no significant differences in length, width and thickness among group A,B,C,D (p-value>.05). Comparing A,B,C,D with E, there are also significant differences in length, width, thickness (p-value<.05) Comparing control group with group E,there are significant differences in length, width (P p-value<05) except for thickness (p-value>.05) 2The internal echo characteristics of thyroid glandA group(n=47) mainly has rarefaction distribution31/47(66%) or moderate distribution9/47(19%) of reduced echo and localized reduced echo7/47(15%); B group(n=25) has diffuse reduced echo without thin-thread high echo11/25(44%) and intense diffuse low level latticed echo9/25(35%), posterior border of thyroid has no lace shape; C group(n=46) mainly has intense diffuse low level latticed echo, posterior border of thyroid has lace shape42/46(91.4%); D group(n=43) has reduced diffuse echo but characterized with thin-thread high echo41/43(95%), posterior border of thyroid has significant lace shape43/43(100%); E group(n=33) results showed similar with group D33/33(100%) except that the shape of thyroid shrink, the entire shape presents to be lobulated33/33(100%). There are obvious differences among each groups in incidence rate of acoustic characteristic (p-value<.05).3Color Doppler flow image(CDFI) of thyroid and Doppler features of superior thyroid artery3.1CDFI of thyroidIn control group, blood flow signals is not abundant, showing only in major blood vessels in borderline of thyroid or showing sparse distribution of fascicular and points blood flow signals within the organization, and CDFI of control group present level0or level Ⅰ, while in group A,B,C and D group, there are increased blood flow signals in the thyroid gland, part of patients are full of color flow signals in the thyroid. The differences were statistically significant (p-value<.05), while the differences among group A,B,C and D was no significant difference (p-value>.05). The CDFI of group E mainly present level0or level I, Comparing with control group, there are no significant differences(p-value>.05).3.2The superior thyroid artery systolic maximum velocity (Vmax)Comparing group A (34.80±9.16),B (71.64±17.39),C (49.39±14.50) and D(50.70±14.62) with control group(21.80±5.96) and group E(20.92±8.84), there are significant differences in Vmax (p-value<.05), Vmax of each group with disease is higher than control group except for group E. The Vmax of group B is higher than group A, C and D. the differences present significance (p-value<.05). Comparing group C and D with group A, there are significant difference (p-value>.05), while comparing group C with group D, there are no significant difference (p-value>.05). Group E compared with control group has no significant difference (p-value>.05).3.3Resistance Index (RI) of the superior thyroid arteryComparing group A (0.60±0.08),B (0.62±0.09),C (0.60±0.12),D (0.61±0.08) and E (0.62±0.10) with control group (0.55±0.08), there are significant differences in RI (p-value<.05), RI of each groups with disease is all higher than control group, while there are no significant differences among groups with disease (p-value>.05).Conclusion1.All cases abnormal acoustic image at different stage mean that high-frequency ultrasonography has high sensitivity rate to finding of HT. Consequently the index of the examination methods can be used as diagnostic and evaluation criterion of HT and HT with hypothyroidism.2.The length, width and thickness of HT group except for patients with atrophic thyroid increaser than normal thyroid in each size and thickness’ increases were marked, but there are no significant difference among each period of HT.3. Wide and diffuse distribution of reduced echo in whole thyroid become acoustic image foundation of HT hypothyroidism; Observing high-level echo of thin-thread form and lace shape in posterior border of thyroid are the characteristic and diagnostic sign of hypothyroidism. using it, we can differentiate temple Hashitoxicosis period and hypothyroidism period. Subclinic hypothyroidism and clinic hypothyroidism possess their acoustic properties respectively. The sonographic appearance of subclinic hypothyroidism mainly display as intense diffuse distribution of latticed low level echo with lace-shape posterior border of thyroid while clinical hypothyroidism has reduced diffuse echo but characterized with thin-thread high-level echo and signifiant lace shape of posterior border of thyroid. What the entire presents to be lobulated and the shape of thyroid shrink are appearance of advanced clinical hypothyroidism.4. There are increased blood flow signals in the thyroid gland with HT except for patients with atrophic thyroid. The color Doppler pattern of intense hypervascularization of the thyroid gland formerly attributed only to the hyperthyroid state of active Graves’Disease can also be seen in hypothyroidism. Our data support the concept that the color flow appearance is not the result of stimulated thyroid hormone production.5. Vmax of superior thyroid artery with HT except for patients with atrophic thyroid were higher than nomal state. The Vmax with HT hashitoxicosis were the highest among all groups. The Vmax with HT hypothyroidism were higher than the nomal thyroid function with HT and lower than HT hashitoxicosis. We could differentiate temple Hashitoxicosis period and hypothyroidism period by using Vmax of superior thyroid artery. RI of superior thyroid artery with HT is higher than nomal state, but there are no marked difference among each period of HT. |
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