Thyroid sonography as an extension of the bedside examination in hyperthyroidism

Abstract

In this mini-review, we examine the utilization of thyroid sonography as a ‘point-of-care’ tool for assessing and managing patients with (suspected) hyperthyroidism who present to the endocrine outpatients. Thyroid USS may aid the distinction between hyperthyroidism and destructive thyroiditis. Presence of intense vascularity (‘thyroid inferno’) on power Doppler has a very high positive predictive in identifying hyperthyroidism. It may also allow the sub-classification of hyperthyroidism into autoimmune and nodular hyperthyroidism. The presence of thyroid nodules is important to acknowledge at an early stage as this may affect management. Not only toxic nodules are managed with definitive treatment, but the presence of nodules is important to be clarified in Graves’ disease because of the evidence of an increased risk of malignancy and, possibly, more aggressive behaviour if malignant disease is confirmed. Current guidelines on hyperthyroidism do not clearly state thyroid sonography as a first line investigation although recent authoritative reviews point in that direction. Given the aforementioned benefits of thyroid sonography, alongside the reduced costs and widespread availability of high-resolution (including portable) ultrasound devices, there is an argument for thyroid sonography to be applied as a first line investigation for all patients with hyperthyroidism. More precisely, formally trained endocrinologists could perform thyroid sonography as an extension of their clinical examination when patients first present with hyperthyroidism in the endocrine clinic.