[Ultrasonography of the thyroid and parathyroid gland].
Klinikum am Steinenberg, Kreiskliniken, 72710, Reutlingen.Der Internist (Impact Factor: 0.31). 08/2006; 47(7):729-46; quiz 747.
Ultrasonography is the most important imaging tool in the diagnosis of thyroid disease. The results of real-time B-imaging of the thyroid gland along with physical signs and basal TSH can aid in the diagnosis of thyroid dysfunction, of for instance, a small, hypoechogenic gland in Hashimoto's and radiation thyroiditis, or an enlarged, hypoechogenic and pulsating gland in Graves' disease. Although recent improvements in technology have increased sensitivity of colored duplexsonography, certain sonographic differentiation of benign and malignant lesions as well as of active (hormone secreting) and inactive nodules is not yet possible. Diagnostic interpretation of ultrasonographic findings is feasible only when the history of the patient, physical examination and the laboratory evaluation are taken into account. Ultrasound detects thyroid nodules, is useful for following nodule size, in guiding fine needle biopsies and in the aspiration of cysts. Highly experienced investigators in ultrasound can assist preoperatively in the localization of parathyroid adenomas in primary and tertiary hyperthyroidism (when followed by (99m)Tc szintigraphy plus SPECT).
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ABSTRACT: We investigated the demographic and clinical features of patients with Hashimoto's thyroiditis who had been diagnosed and treated in Ege University, the main referral center in the Aegean region of Turkey. Medical records of patients who had been followed in the endocrinology clinic of Ege University were retrospectively evaluated. Patients who had been diagnosed as having any thyroid disorder were determined. Patients with Hashimoto's thyroiditis were selected among those patients. Seven hundred and sixty-nine patients fulfilled diagnostic criteria for Hashimoto's thyroiditis (725 females, 44 males; mean age 41.76 ± 12.49 years). 62.7% of patients were between 30 and 50 years of age. 53.3% of females and 63.6% of males had diffuse enlargement of the thyroid gland. TSH level was above 4.0 IU/l in 25.6% of females and 27.4% of males. Anti-tyroglobulin antibody was positive in 92% of females and 93.2 % of males. Anti-thyroid peroxidase antibody was positive in 98.4 % of females (713 patients) and 100% of males. Thyroid ultrasonography demonstrated single nodule in 52.2% and multiple nodules in 11.3% of female patients; and single nodule 32% and multiple nodules in 20% of male patients. Fine-needle aspirations of the nodules were performed in 207 patients, and none of those biopsies was diagnosed as malignant. Women with suspicious biopsis were operated. After surgery, we found that, 2% (n = 4) of patients with FNAC diagnosis of suspicious biopsies were papillary carcinoma and the other patients (3% (n = 6)) were lymphocytic thyroiditis. Age and sex distribution and laboratory findings of our patients were comparable to the previous reports. Nodule formation was the most common ultrasonographic finding in our patients, probably due to pseudonodularity. We found four women patients with thyroid cancer in our population.
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ABSTRACT: Hashimoto's thyroiditis is a common autoimmune thyroid disease with preference of female gender. The chronic thyroiditis is characterized by autoantibodies against thyroid peroxidase and thyroglobulin. With manifestation, there is often a subclinical hypothyroidism that finally progresses to a persistent hypothyroidism with typical clinical symptoms and the need of hormonal substitution in succession of the lymphocytic infiltration of the thyroid. The ultrasound of the thyroid shows a hypoechogenic and inhomogeneous parenchyma. Autoimmune thyroiditis is frequently associated with autoimmune disease of other organs, such as vitiligo, Addison's disease, diabetes mellitus type 1, often in the sense of polyglandular syndrome 2.
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ABSTRACT: Objectives: Patients with Hashimoto thyroiditis show structural changes of the thyroid that can be identified by a variety of sonographic criteria. We conducted this study to investigate whether there is a correlation between sonography and antibody activity and to assess the role of sonography in the diagnosis and follow-up of Hashimoto thyroiditis. In addition, we present a new classification system (termed the VESINC system [volume, echogenicity, sonographic texture, pseudonodular hypoechoic infiltration, nodules, and cysts]), which helps improve the clarity of sonographic findings. Methods: The study included 223 consecutive patients with previously diagnosed Hashimoto autoimmune thyroiditis who attended the thyroid clinic of the German Armed Forces Central Hospital in Koblenz for follow-up examinations between 2006 and 2008. Laboratory tests were performed to measure the levels of free triiodothyronine, free thyroxine, thyrotropin, anti-thyroglobulin antibodies (TgAbs), and antithyroid peroxidase antibodies (TPOAbs). Sonography was performed according to a strict protocol. We then assessed whether a correlation existed between antibody activity and the 6 sonographic variables of the VESINC system. Results: Hypoechogenicity, heterogeneity, and pseudonodular hypoechoic infiltration were associated with significantly higher TPOAb activity (P < .001). There were no significant correlations between the other sonographic variables examined (cysts, nodules, and volume) or the biometric data with the TPOAb and TgAb levels. In addition, an assessment of TgAb levels did not show significant differences in correlations with any of the sonographic variables. Conclusions: Sonography is a noninvasive diagnostic imaging modality that provides information about the level of inflammatory activity. Markedly decreased echogenicity, heterogeneity, and multifocal pseudoinodular hypoechoic infiltration are indicative of a high level of inflammatory activity. The sonographic classification system presented here (VESINC system) can be a useful tool for comparing sonographic findings in a rapid and objective manner during follow-up of Hashimoto thyroiditis.
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