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Li S, Ding Z, Li X, Fu M, Sang L, Yang M, Tang R, Gu T, Sang L. A meta-analysis: elucidating diagnostic thresholds of peak systolic flow velocities in thyroid arteries for the discrimination of Graves' disease and destructive thyrotoxicosis. Front Endocrinol (Lausanne) 2024; 15:1393126. [PMID: 38911037 PMCID: PMC11190173 DOI: 10.3389/fendo.2024.1393126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Objective This meta-analysis examines peak systolic velocities (PSVs) in thyroid arteries as potential biomarkers for thyroid disorders, which includes treated and untreated Graves' disease(GD) and destructive thyrotoxicosis(DT). Methods A search across databases including PubMed, Google Scholar, Embase, and Web of Science identified studies assessing peak systolic flow velocity in the inferior thyroid artery (ITA-PSV) and superior thyroid artery (STA-PSV) diagnostic efficacy in GD and DT.And the search was restricted to publications in the English language.The analysis compared STA-PSV and ITA-PSV across patient groups, evaluating intra-group variances and synthesizing sensitivity and specificity data. Results The analysis covered 18 studies with 1276 GD, 564 DT patients, and 544 controls. The difference of STA-PSV between GD group, DT group and normal group and the difference of ITA-PSV were analyzed in subgroups, and there was no statistical significance between subgroups when comparing any two groups. Normal subjects displayed intra-group ITA-PSV and STA-PSV differences with established cut-off values of 20.33 cm/s (95% CI, 17.48-23.18) for ITA-PSV and 25.61 cm/s (95% CI, 20.37-30.85) for STA-PSV. However, no significant intra-group differences were observed in the STA-PSV and ITA-PSV cut-off values among groups with GD or DT. The combined cut-off values for these patient groups and normal subjects were 68.63 cm/s (95% CI, 59.12-78.13), 32.08 cm/s (95% CI, 25.90-38.27), and 23.18 cm/s (95% CI, 20.09-26.28), respectively. The diagnostic odds ratio(DOR) for these values was 35.86 (95% CI, 18.21-70.60), and the area under the summary receiver operating characteristic (SROC) curve was 0.91, with a sensitivity estimate of 0.842 (95% CI, 0.772-0.866). Conclusion PSVs in thyroid arteries are useful diagnostic tools in distinguishing DT from GD. A PSV above 68.63 cm/s significantly improves GD diagnosis with up to 91% efficacy. No notable differences were found between superior and inferior thyroid arteries in these conditions.
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Affiliation(s)
- Sinong Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zheng Ding
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiang Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Miao Fu
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Li Sang
- Department of Acupuncture and Massage, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, China
| | - Mingxia Yang
- Department of Ultrasound, Shouguang People’s Hospital, Shouguang, China
| | - Rubo Tang
- Department of Cardiology, Shouguang People’s Hospital, Shouguang, China
| | - Tianxiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Wang J, Wan K, Chang X, Mao RF. Association of autoimmune thyroid disease with type 1 diabetes mellitus and its ultrasonic diagnosis and management. World J Diabetes 2024; 15:348-360. [PMID: 38591076 PMCID: PMC10999045 DOI: 10.4239/wjd.v15.i3.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 03/15/2024] Open
Abstract
As a common hyperglycemic disease, type 1 diabetes mellitus (T1DM) is a complicated disorder that requires a lifelong insulin supply due to the immune-mediated destruction of pancreatic β cells. Although it is an organ-specific autoimmune disorder, T1DM is often associated with multiple other autoimmune disorders. The most prevalent concomitant autoimmune disorder occurring in T1DM is autoimmune thyroid disease (AITD), which mainly exhibits two extremes of phenotypes: hyperthyroidism [Graves' disease (GD)] and hypo-thyroidism [Hashimoto's thyroiditis, (HT)]. However, the presence of comorbid AITD may negatively affect metabolic management in T1DM patients and thereby may increase the risk for potential diabetes-related complications. Thus, routine screening of thyroid function has been recommended when T1DM is diagnosed. Here, first, we summarize current knowledge regarding the etiology and pathogenesis mechanisms of both diseases. Subsequently, an updated review of the association between T1DM and AITD is offered. Finally, we provide a relatively detailed review focusing on the application of thyroid ultrasonography in diagnosing and managing HT and GD, suggesting its critical role in the timely and accurate diagnosis of AITD in T1DM.
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, Jiangsu Province, China
| | - Ke Wan
- Faculty of Medicine and Health, The University of Sydney, Camperdown NSW 2050, Australia
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, Jiangsu Province, China
| | - Rui-Feng Mao
- School of Life Science, Huaiyin Normal University, Huai'an 223300, Jiangsu Province, China
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Huang J, Zhao J. Quantitative Diagnosis Progress of Ultrasound Imaging Technology in Thyroid Diffuse Diseases. Diagnostics (Basel) 2023; 13:diagnostics13040700. [PMID: 36832188 PMCID: PMC9954877 DOI: 10.3390/diagnostics13040700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
High-frequency ultrasound (HFUS), the imaging modality of choice for thyroid screening, is most commonly used in the study of diffuse thyroid disease (DTD) with Hashimoto's thyroiditis (HT) and Graves' disease (GD). DTD can involve thyroid function and severely affect life quality, so early diagnosis is important for the development of timely clinical intervention strategies. Previously, the diagnosis of DTD relied on qualitative ultrasound imaging and related laboratory tests. In recent years, with the development of multimodal imaging and intelligent medicine, ultrasound and other diagnostic imaging techniques have gradually become more widely used for quantitative assessment of the structure and function of DTD. In this paper, we review the current status and progress of quantitative diagnostic ultrasound imaging techniques for DTD.
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Affiliation(s)
- Jing Huang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China
| | - Jiaqi Zhao
- Department of Ultrasound, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
- Correspondence: ; Tel.: +86-21-5560-3999
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Hefeda MM. Value of the New Elastography Technique using Acoustic Radiation Force Impulse in Differentiation between Hashimoto's Thyroiditis and Graves' Disease. J Clin Imaging Sci 2019; 9:17. [PMID: 31448168 PMCID: PMC6702860 DOI: 10.25259/jcis-22-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background and Aim: This study was performed to evaluate the role and accuracy of shear wave elastography in the differentiation between Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), in comparison with the B-mode ultrasound and color Doppler ultrasound. Materials and Methods: This study was non-randomized prospective study. The study included 30 patients with GD, 65 patients with HT, and 35 patients with normal thyroid glands. Assessment of ultrasonographic criteria, color Doppler flow pattern, and shear patterns differed significantly between the control group and the group of diffuse thyroid disease (P < 0.001). The most specific sign for diagnosing HT was nodularity (97.87%), and the most sensitive sign was coarse echotexture (81.54%). Color Doppler flow (CDF) showed sensitivity of 91.8%, specificity of 56.92%, positive predictive value of 52.54%, negative predictive value of 92.5%, and diagnostic accuracy of 68.69% in the differentiation between GD and HT. The mean shear wave velocity (SWV) was 2.61 ± 0.32 m/s in the GD group (range: 2.1–3.21 m/s), 2.85 ± 0.52 m/s in the HT group (range: 2.31–3.82 m/s), and 1.75 ± 0.37 m/s in the control group (range: 1.24–2.36 m/s). The mean SWVs in the GD and HT groups were significantly higher than that in the control group (P < 0.001). The mean SWV in the HT group was higher than that in the GD group (P = 0.03). Conclusion: Quantitative and qualitative SWE is useful for diagnosing diffuse thyroid disease and evaluating the degree of fibrosis in autoimmune thyroiditis. However, acoustic radiation force impulse techniques cannot differentiate between HT and GD reliably.
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Szczepanek-Parulska E, Klubo-Gwiezdzinska J, Ruchala M. Editorial: Novel Imaging Techniques in the Management of Thyroid Nodules and Autoimmune Thyroid Disease. Front Endocrinol (Lausanne) 2019; 10:804. [PMID: 31824421 PMCID: PMC6879449 DOI: 10.3389/fendo.2019.00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/04/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Klubo-Gwiezdzinska
- Thyroid Tumors and Functional Thyroid Disorders Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, United States
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Marek Ruchala
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Struja T, Kaeslin M, Boesiger F, Jutzi R, Imahorn N, Kutz A, Bernasconi L, Mundwiler E, Mueller B, Christ-Crain M, Meienberg F, Ebrahimi F, Henzen C, Fischli S, Kraenzlin M, Meier C, Schuetz P. External validation of the GREAT score to predict relapse risk in Graves' disease: results from a multicenter, retrospective study with 741 patients. Eur J Endocrinol 2017; 176:413-419. [PMID: 28100628 DOI: 10.1530/eje-16-0986] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT First-line treatment in Graves' disease is often done with antithyroid agents (ATD), but relapse rates remain high making definite treatment necessary. Predictors for relapse risk help guiding initial treatment decisions. OBJECTIVE We aimed to externally validate the prognostic accuracy of the recently proposed Graves' Recurrent Events After Therapy (GREAT) score to predict relapse risk in Graves' disease. DESIGN, SETTING AND PARTICIPANTS We retrospectively analyzed data (2004-2014) of patients with a first episode of Graves' hyperthyroidism from four Swiss endocrine outpatient clinics. MAIN OUTCOME MEASURES Relapse of hyperthyroidism analyzed by multivariate Cox regression. RESULTS Of the 741 included patients, 371 experienced a relapse (50.1%) after a mean follow-up of 25.6 months after ATD start. In univariate regression analysis, higher serum free T4, higher thyrotropin-binding inhibitor immunoglobulin (TBII), younger age and larger goiter were associated with higher relapse risk. We found a strong increase in relapse risk with more points in the GREAT score from 33.8% in patients with GREAT class I (0-1 points), 59.4% in class II (2-3 points) with a hazard ratio of 1.79 (95% CI: 1.42-2.27, P < 0.001) and 73.6% in class III (4-6 points) with a hazard ratio of 2.24 (95% CI: 1.64-3.06, P < 0.001). CONCLUSIONS Based on this retrospective analysis within a large patient population from a multicenter study, the GREAT score shows good external validity and can be used for assessing the risk for relapse in Graves' disease, which influence the initial treatment decisions.
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Affiliation(s)
- Tristan Struja
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Marina Kaeslin
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Fabienne Boesiger
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Rebecca Jutzi
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Noemi Imahorn
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Alexander Kutz
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Luca Bernasconi
- Department of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland
| | - Esther Mundwiler
- Department of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
- Medical Faculty of the University of BaselBasel, Switzerland
| | - Mirjam Christ-Crain
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Fabian Meienberg
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Christoph Henzen
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, Kantonsspital Luzern, Luzern, Switzerland
| | - Stefan Fischli
- Clinic for EndocrinologyDiabetes & Metabolism, Kantonsspital Luzern, Luzern, Switzerland
| | - Marius Kraenzlin
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Christian Meier
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
- Medical Faculty of the University of BaselBasel, Switzerland
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Okosieme OE, Lazarus JH. Current trends in antithyroid drug treatment of Graves' disease. Expert Opin Pharmacother 2016; 17:2005-17. [PMID: 27615550 DOI: 10.1080/14656566.2016.1232388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Graves' hyperthyroidism is associated with significant morbidity and mortality risk. The thionamides, methimazole, its pro-drug derivative carbimazole, and propylthiouracil, remain a cornerstone of management. Yet despite decades of use, optimal strategies for maximising treatment response and curtailing adverse effect risk remains uncertain. AREAS COVERED We reviewed the current literature on the evidence based medical management of Graves' disease. Specifically, we evaluated current approaches to the use of thionamides, adjunctive therapies, and potential novel agents for controlling Graves' hyperthyroidism. EXPERT OPINION Primary medical therapy is successful in less than 50% of cases and so careful selection of patients for medical treatment based on a combination of pathological and pragmatic considerations is essential. Carbimazole or methimazole is the treatment of choice in the non-pregnant population driven by its more favourable pharmacokinetic and adverse effect profile over propylthiouracil. In pregnancy the choice of treatment is less straightforward and an approach that minimises undue fetal exposure to all thionamides should be adopted. Additional data is needed on the value of adjunctive therapies including potassium perchlorate, iodides, glucocorticoids, lithium, and cholestyramine. Novel agents directed against pathogenetic targets including TSH receptor blocking monoclonal antibodies and small molecule antagonists may hold promise for the future.
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Affiliation(s)
- Onyebuchi E Okosieme
- a Thyroid Research Group, Institute of Molecular and Experimental Medicine , School of Medicine, Cardiff University , Cardiff , UK.,b Endocrine and Diabetes Department , Prince Charles Hospital, Cwm Taf University Health Board , Merthyr Tydfil , UK
| | - John H Lazarus
- a Thyroid Research Group, Institute of Molecular and Experimental Medicine , School of Medicine, Cardiff University , Cardiff , UK
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Chen L, Zhao X, Liu H, Wang Y, Li L, Lu B, Li Y, Hu R. Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J Int Med Res 2012; 40:640-7. [PMID: 22613425 DOI: 10.1177/147323001204000226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between mean superior thyroid artery peak systolic velocity (STA-PSV) and radioactive iodine uptake (RAIU) in Chinese patients with untreated thyrotoxicosis, using retrospectively and prospectively collected data. METHODS Patients with untreated thyrotoxicosis (n = 220) and euthyroid control subjects (n = 30) underwent thyroid function, thyroid autoantibody and thyroid ultrasonography tests. Mean STA-PSV was measured by ultrasonography. RAIU tests identified 168 patients with Graves' disease and 52 with destructive thyroiditis. Linear correlation of mean STA-PSV with 3-h and 24-h RAIU, and sensitivity, specificity and receiver operating characteristic (ROC) curves for mean STA-PSV in the differential diagnosis of Graves' disease and destructive thyroiditis were calculated. RESULTS Mean STA-PSV was significantly higher in Graves' disease than in destructive thyroiditis. Mean STA-PSV correlated positively and significantly with 3-h and 24-h RAIU. Area under the ROC curve of mean STA-PSV for the differential diagnosis of Graves' disease and destructive thyroiditis was 0.825 (optimum cut-off value of mean STA-PSV, 45.25 cm/s; sensitivity, 80.4%; specificity, 81.4%). CONCLUSIONS Detection of mean STA-PSV by ultrasonography agrees with RAIU and is useful for the differential diagnosis of thyrotoxicosis in Chinese patients.
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Affiliation(s)
- L Chen
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Kangelaris GT, Kim TB, Orloff LA. Role of ultrasound in thyroid disorders. Otolaryngol Clin North Am 2011; 43:1209-27, vi. [PMID: 21044737 DOI: 10.1016/j.otc.2010.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders, both malignant and benign. Although its use has traditionally been the domain of radiologists, surgeons and endocrinologists are increasingly integrating this technology into their daily clinical and operative practice. This article provides an overview of the relevant uses and indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and reviews the relevant literature and guidelines concerning its uses.
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Affiliation(s)
- Gerald T Kangelaris
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA 94115, USA
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Abdel Razek AAK, Sadek AG, Gaballa G. Diffusion-weighed MR of the thyroid gland in Graves' disease: assessment of disease activity and prediction of outcome. Acad Radiol 2010; 17:779-83. [PMID: 20350826 DOI: 10.1016/j.acra.2010.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/13/2010] [Accepted: 01/15/2010] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the activity and clinical course of Graves' disease with diffusion-weighted magnetic resonance (MR) imaging. MATERIALS AND METHODS Fifty-one patients with Graves' disease and 25 volunteers underwent diffusion MR imaging of the thyroid gland using a single shot echo-planar imaging with b-factor of 0, 300 and 600 second/mm(2). The apparent diffusion coefficient (ADC) values of the thyroid gland were calculated. Patients with active Graves' disease included untreated patients at initial diagnosis (n = 12), patients under antithyroid drugs (n = 11), and patients in relapse after withdrawal of therapy (n = 13). Patients with inactive disease had a remission of hyperthyroidism (n = 15). RESULTS The mean ADC values of thyroid gland with active Graves' disease was 0.65 +/- 0.03 x 10(-3) mm(2)/second in patients at initial diagnosis, 0.81 +/- 0.02 x 10(-3) mm(2)/second in patients undergoing antithyroid drug and 0.72 +/- 0.07 x 10(-3) mm(2)/second in patients with relapse of hyperthyroidism. The mean ADC of patients with remission was 0.94 +/- 0.03 x 10(-3) mm(2)/second and for normal volunteer was 1.06 +/- 0.08 x 10(-3) mm(2)/second. There was significant difference in the ADC value of patients with active disease and remission (P = .001). The cutoff ADC value used for differentiating patients with active disease from patients with remission was 0.82 x 10(-3) mm(2)/second. The mean ADC value of thyroid gland had positive correlation with thyroid-stimulating hormone (r = 0.87, P = .001) and negative correlation with serum T4 (r = -0.82, P = .001) and serum T3 (r = -0.71, P = .001). CONCLUSIONS The ADC value of the thyroid gland is a promising non invasive parameter for diagnosis of different clinical stages of Graves' disease. Hence it can be used to assess the activity and predict the outcome of patients during and after medical treatment.
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Wu CC. Duplex Doppler Ultrasonography for the Functional Evaluation of Diffuse Thyroid Diseases. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60126-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Turgut AT, Çakal E, Koşar U, Koşar P, Demirbaş B, Aral Y. Maximum Systolic Velocity of Inferior Thyroid Artery and Thyroideal Color Doppler Flow Pattern in Hypothyroid Subjects Before and After Treatment. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60014-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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