Value Of Thyroid Artery Hemodynamics In Differentiating Thyroid Diffuse Lesions

Objective: To investigate the value of the hemodynamic changes of the thyroid artery in the diagnosis and differential diagnosis of diffuse thyroid lesions.Methods: We collected 600 cases of thyroid diffuse lesions including 200 patients with toxic diffuse goiter,200 cases of Hashimoto's thyroiditis and 200 cases of subacute thyroiditis in our hospital in December 2016-2018.There are 114 men and 486 women,15~60(39.3 + 12.9)years old.According to the type of disease,3 groups were divided: 200 cases of Graves' disease named GD,200 cases of Hashimoto's thyroiditis(Hashimoto 's thyroiditis,HT)named HT,200 cases of subacute thyroiditis(Subacute thyroiditis,SAT)were group SAT,the other 150 healthy subjects were normal group,150 cases were physical examination and serological examination were normal.Measured thyroid volume(method:first measurement about thyroid lobe and isthmus of each path,and then to the ellipse formula V=?/6×length×width×thickness to calculate the diameter of each lobe volume,Finally,adding the volume of each leaf),to observation of thyroid structure and echo parameter characteristics;measuring arterial blood flow parameters on thyroid volume,including the superior thyroid artery peak systolic velocity(PSV)and systolic acceleration time(AT);We recorded the heart rate and the product of PSV and heart rate(PVH)of the patients.by automated chemiluminescence immunoassay of three iodine thyroid original acid free detection of serum(FT3),free triiodothyronine four(FT4),thyroid stimulating hormone(TSH)level,analysis of diffuse thyroid lesions in patients with thyroid related arterial parameters and serum FT3,FT4,PVH and TSH.Results:1.GD group,HT group and SAT group all had different degrees of thyroid enlargement.Compared with the normal group,the difference of the upper and the lower diameter,the left and right diameter,the thickness of the isthmus and the thyroid volume of the three groups were statistically significant(P<0.05),but the difference of the isthmus transverse diameter of the 4 groups had no sense of unity(P>0.05).2.The thyroid blood flow in the normal control group was limited to the perimeter of the thyroid gland.There was no obvious blood flow or only a few scattered on the spot or short strip blood flow signals in the parenchyma.The blood flow signals in the parenchyma of the thyroid gland in GD and HT were obviously increased.Most of them were "Fire Sea sign".In some patients with GD and HT,the blood flow of the thyroid parenchyma was mainly concentrated in the anterior 2/3 of the thyroid gland;the peripheral blood flow in the hypoechoic region of the thyroid parenchyma was visible in the SAT group,and only a few punctate blood flow signals were found in the thyroid gland.3.In GD group,HT group and SAT group,PSV and PVH were all higher than the normal group.GD group was significantly higher than the other ones.AT of HT and SAT group were higher than the GD and the normal group,the difference was statistically significant(P<0.05);And there were significant differences among PSV,PVH and AT among groups(F=5.289,F=6.251,F=2.695,P<0.05).The difference between the GD group and the normal group was the most significant,followed by the HT.4.PSV,PVH and AT in GD group and HT group were positively correlated with FT3 and FT4 in serum(P<0.05),but negatively correlated with TSH(P<0.05);The correlation between PSV,PVH,AT and serum FT3 and FT4 was higher than that of TSH;There was no correlation between PSV,PVH,AT and serum FT3,FT4 and TSH in SAT group;The correlation between PSV,PVH,AT and serum FT3,FT4 and TSH decreased significantly with the increase of FT3 and FT4 levels;When FT3 and FT4 were close to the upper limit of detection,the correlation between PSV,PVH and AT was not correlated.Conclusion:1.The main feature of the thyroid diffuse lesion is different degrees of thyroid enlargement.Due to the different causes of various diseases,the location,degree,internal echo and blood flow distribution of the thyroid enlargement are different,so it should be combined with its medical history,clinical symptoms,and laboratory examination(thyroid function examination)to make a comprehensive judgment.2.The hemodynamic indexes of the superior thyroid artery including PSV,PVH and AT reflect the thyroid function to some extent,and can be used in the diagnosis and differential diagnosis of thyroid diffuse disease.It is not only simple and accurate,but also provides a certain reference for the formulation of treatment strategy,observation of curative effect and improvement of the quality of life of the patients.