Abstract
Thyroiditis is inflammatory disorder of thyroid with wide spectrum of clinical presentation. Thyroid function may be normal, high or low in valve. The presentation of symptoms, family history is of importance. Hashimoto’s thyroiditis is not an uncommon cause of hypothyroidism in young population. Ultrasound is the imaging modality of choice in diagnosis of thyroid disorders. Thyroid ultrasonography is a simple, non -invasive, reproducible and without use of radiation with high sensitivity in diagnosis of thyroiditis. The purpose of this study was to determine the sensitivity and specificity of gray scale sonographic findings in Hashimoto’s thyroiditis and its clinico-cytological correlation.
Introduction: Thyroiditis is defined as the inflammation of the thyroid gland and classified as acute/sub acute, chronic or autoimmune thyroiditis. Autoimmune thyroid disease AITD includes two major clinical presentations; Grave’s Disease (GD) and Hashimoto's Thyroiditis (HT)1. The prevalence of AITD is approximately 5% with clinical presentation of hyperthyroidism or hypothroidism2. The pathogenesis is not very clear, there may be environmental factors, infection, drugs, smoking, etc. ,could trigger AITD in susceptible persons3.TUS findings in HT includes diffuse enlargement with decreased echogenicity, heterogeneity with hypervascularity and presence of hypo echoic micro nodules with echogenic rim. Cytological diagnosis is superior in children and as in initial stages of HT, antibody production may be limited. FNAC is quick, cost-effective and highly sensitive in diagnosis of HT4.Most of the HT cases are in young and pre-menopausal females and more prone for poor obstetrical and fetal outcome, therefore early diagnosis of HT on clinical, TUS and cytology is of importance for supplementation of thyroxin for associated hypothyroidism.
Keywords: Hashimoto’s thyroiditis HT, Grave's Disease GD, Autoimmune Thyroid disease AITD, Hypothyroidism, Thyroid Ultra Sonography-TUS, CD Color Doppler.
References
- Zhaohui Cui.et al. Establishment of clinical diagnosis model of Grave's disease and Hashimoto' thyroiditis. Journal of Translational Medicine. 2019,17:11, http://doi.org/10.1186/s12967-018-1765-3.
- Antonell A et al Autoimmune thyroid disorders. Autoimmune. Rev. 2015;14(2):174-80
- Shukla SK. etal. Infections, genetic and environmental factors in pathogenesis of autoimmune thyroid disease .Mico Pathog. 2018;116:279-88.
- Shetty A. Chowdappa V. Cytomorphological Spectrum of Hashimoto;s Thyroiditis and Its Correlation with Hormonal Profile and Hematological Parameters. Journal of Cytology.2019;36:137-41.
- Takahashi MS et al. Ultrasound Evaluation of Thyroiditis: A Review.Journal of Otolaryngology Research.2019;2(1):127.01-09.
- Aleksandra Pyzik et al. Immune Disorders in Hashimoto's Thyroiditis: What Do We Know So Far ?. Journal of Immunology Research. Volume 2015,Article ID 979167,8 pages.
- Debmalya Sanyal. Spectrum of Hashimoto's Thyroidits: Clinical, Biocchemical & Cytomorphologic profile. Indian J Med Res.140, December 2014, pp.710-712.
- Katja Zalete and Simona Gaberscek. Hashimoto's Thyroiditis: From Genes to the Disease. Current Genomics, 2011, 12,576-588.
- Mazziotti G. Gray-scale analysis allows a quantitative evaluation of thyroid echogenicity in the patients with Hashimoto's thyroiditis. Clin Endocrinol (Oxf). 2003.59:223-229.
- Langer JE et al. Sonographic apperance of focal thyroiditis. AJR. Am J Roentgenol. 2001.176:751-754.
- Yeh HC et al. Micronodulation: Ultrasonographic sign of Hahimoto;s thyroiditis.J Ultrasound Med .1996.15:813-819.
- Virmani V, Hammond I.Sonographic patterns of benign thyroid nodules: verification at our institution .AJR,Am J Roentgenol.2011,196:891-895.
- Sawin CT. Hakaru Hashimoto and his disease The Endocrinologist 2002.49: 399-403.
- Halm LE. Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl.J Med 1985.312:601-604.
- Dos Santos TARR et al. Grave's Disease Thyroid Color-Flow Doppler Ultrasonography Assessment Health 2014,6:1487-1496.
- Anderson L et al.Hashimoto thyroiditis.Part2. Sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. AJR, Am J Roentgenol.2010.195:216-22.
- Donkol R H et al.Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis. World J Radiol.2013;5:178-83.
- Stein S A et al.primary thyroid lymphoma: a clinical review. J Clin Endocrinol. Metlab.2013;89:3131-8.
- Thomas T et al. Clinical, biochemical & Cytomorphphologic study on Hashimoto's thyroiditis. Indian J Med. Res. 2014;140:729-35.
- Bhatia A .et al. Lymphocytic thyroiditis- is cytological grading significant?.A correlation of grades with clinical, biochemical, ultrasonographic and radionuclide parameters. Cytojournal. 2007:4:10.
Corresponding Author
Dr Pranav K Dave
Asso. Prof. Deptt. of Radiology