Abstract
Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5–15 MHz linear probe). Five valid measurements for the parenchyma/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 ± 2.11 vs. 1.03 ± 0.51; p < 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 ± 2.53 vs. 2.15 ± 1.27, p < 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis.
Highlights
Chronic autoimmune thyroiditis (CAT) is represented by nonspecific, chronic and irreversible inflammation of the thyroid, defined by the presence of specific antibodies against the thyroid structure, which are anti-thyroid peroxidase (ATPO) antibodies and antithyroglobulin (ATG) antibodies.As described by the histologic examination, the disease is characterized by various degrees of fibrosis along with the presence of lymphoid follicles or atrophic follicles with a small quantity of colloidDiagnostics 2020, 10, 874; doi:10.3390/diagnostics10110874 www.mdpi.com/journal/diagnosticsDiagnostics 2020, 10, 874 containing Hurtle cells
Reliable thyroid elastography measurements using strain elastography were obtained in 250 subjects (100%); all 250 subjects were included in the final analysis
Numerical variables with a normal distribution are presented as a mean value ± standard deviation while variables with a non-normal distribution are presented as median values and range intervals
Summary
Chronic autoimmune thyroiditis (CAT) is represented by nonspecific, chronic and irreversible inflammation of the thyroid, defined by the presence of specific antibodies against the thyroid structure, which are anti-thyroid peroxidase (ATPO) antibodies and antithyroglobulin (ATG) antibodies.As described by the histologic examination, the disease is characterized by various degrees of fibrosis along with the presence of lymphoid follicles or atrophic follicles with a small quantity of colloidDiagnostics 2020, 10, 874; doi:10.3390/diagnostics10110874 www.mdpi.com/journal/diagnosticsDiagnostics 2020, 10, 874 containing Hurtle cells. Chronic autoimmune thyroiditis (CAT) is represented by nonspecific, chronic and irreversible inflammation of the thyroid, defined by the presence of specific antibodies against the thyroid structure, which are anti-thyroid peroxidase (ATPO) antibodies and antithyroglobulin (ATG) antibodies. The presence of an increased titer of anti-thyroid antibodies is described in up to 10–12% of the general population with asymptomatic cases prevailing [3,4]. The prevalence of the disease is greater in the female population and Caucasian individuals, increasing with age and sex steroids fluctuations [3,5,6]. Important evidence supports that a certain genetic susceptibility has a clear role in autoimmune thyroid disease; family clusters and frequent association in cases with Down’s or Turner’s syndrome were observed [7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
