Abstract
ObjectiveTo prospectively evaluate the heterogeneous appearance of the thyroid gland, reflecting inflammation and destruction in euthyroid Hashimoto’s thyroiditis (HT), we investigated the clinical utilities of the heterogeneity index (HI) [the coefficient of variance (CV) of the ultrasonographic (US) intensities], focusing on anti-thyroid peroxidase antibodies (TPO-Ab), which represent not only disease activity but also subsequent thyroid destruction of HT.MethodsForty-four consecutive patients with euthyroid HT [60.5 ± 2.7 years old (mean ± SE)] and 30 age-matched normal controls were studied. HI was calculated as the CV (SD/mean) of US intensities of either four points per lobe of the thyroid gland along a horizontal line at the depth of the right common carotid artery. Evaluation included serum levels of free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), anti-thyroid peroxidase antibodies (TPO-Ab), anti-thyroglobulin antibodies (Tg-Ab), thyroglobulin and thyroid volume.ResultsWhile no differences were observed for TSH, FT4 and FT3, thyroglobulin and thyroid volume between the two groups, HI exhibited a tendency towards a significant difference (3.59 ± 0.20% in HT patients vs 3.23 ± 0.19% in normal group, p = 0.089). In HT patients, there was a significant and positive correlation of HI with TPO-Ab (r = 0.396, p = 0.034), whereas such a correlation was absent in normal controls. In both groups, there were no significant correlations of HI with Tg-Ab, FT3, FT4 or TSH.ConclusionsThis is the first report of the close relation between heterogeneity of US of the thyroid gland and TPO-Ab in euthyroid HT patients before the heterogeneity becomes distinguishable from normal thyroid glands. Furthermore, at this stage, subsequent thyroid destruction in HT might be already be predicted through the heterogeniety of the thyroid tissue.
Highlights
Ultrasonographic (US) examination is a very accurate and highly sensitive method for assessing thyroid gland lesions, especially thyroid nodules, that can be performed quickly even in out-patient clinics [1]
We used a newly-designed sensitive US method that was able to distinguish from the hypoechogenicity [2,3] and enabled to assess and quantify heterogeneity in the euthyroid state, as the heterogeneity index (HI) [coefficient of variance (CV) of the US intensities of eight points of thyroid gland on horizontal line between bilateral common carotid arteries]
thyroid peroxidase antibodies (TPO-Ab) has been established to represent the current activity of Hashimoto’s thyroiditis (HT) and subsequent thyroid destruction, because the TPO-antigen is closely involved with cellmediated cytotoxicity, whereas the thyroglobulin antibodies (Tg-Ab) is not [5]
Summary
Ultrasonographic (US) examination is a very accurate and highly sensitive method for assessing thyroid gland lesions, especially thyroid nodules, that can be performed quickly even in out-patient clinics [1]. We used a newly-designed sensitive US method that was able to distinguish from the hypoechogenicity [2,3] and enabled to assess and quantify heterogeneity in the euthyroid state, as the heterogeneity index (HI) [CV of the US intensities of eight points of thyroid gland on horizontal line between bilateral common carotid arteries]. This method was not affected by depth of the thyroid gland and weakening of ultrasound because it was based on the CV (SD/mean) of the US intensities along a horizontal line. TPO-Ab has been established to represent the current activity of HT and subsequent thyroid destruction, because the TPO-antigen is closely involved with cellmediated cytotoxicity, whereas the Tg-Ab is not [5]
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