Diagnostic Utility of Mean Peak Systolic Velocity of Superior Thyroid Artery in Differentiating Graves’ Disease from Thyroiditis
Background Differentiating Graves’ disease from thyroiditis can be at times clinically challenging. The gold standard test (thyroid nuclear imaging scan) is expensive, not routinely available, and has radiation exposure. Color Doppler ultrasonography of thyroid represents a suitable alternate which can be used for differentiating these conditions by studying thyroid blood flow parameters.
Aim We aimed to investigate the use of thyroid blood flow parameters’ assessment of the superior thyroid artery (STA) and common carotid artery (CCA) with color Doppler ultrasonography for differentiating Graves’ disease from thyroiditis.
Materials and Methods This is a cross-sectional study on 111 patients with newly diagnosed thyrotoxicosis (82 with Graves’ disease and 29 with thyroiditis) and 45 years of age and sex-matched healthy controls. All patients underwent detailed clinical and necessary investigations. Color Doppler ultrasonography of the thyroid gland and spectral flow analysis of both superior thyroid arteries was done using standard protocol. Sensitivity and specificity for mean peak systolic velocity of STA (STA-PSV) cut-offs were calculated using receiver operating characteristic curves.
Results Patients with Graves’ disease have significantly higher free tri-iodothyronine (FT3) levels, free thyroxine (FT4) levels, antithyroid stimulating hormone receptor antibody (TRAb) levels, and thyroid volume as compared with those with thyroiditis. The mean STA-PSV of patients with Graves’ disease was significantly higher than thyroiditis and control group. Mean STA-PSV greater than 54.3 cm/s had 82.9% sensitivity and 86.2% specificity in diagnosing Graves’ disease. Mean PSV-STA/PSV-CCA ratio of 0.40 was 80.5% sensitive and 86.2% specific for Graves’ disease.
Conclusion Mean STA-PSV has high sensitivity and specificity in differentiating Graves’ disease from thyroiditis and can be used routinely in clinical practice as a cheap and invaluable diagnostic tool.
Keywordscolor Doppler - Graves’ diseases - peak systolic velocity - superior thyroid artery - thyroiditis - thyrotoxicosis
27. Juli 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Alzahrani AS, Ceresini G, Aldasouqi SA. Role of ultrasonography in the differential diagnosis of thyrotoxicosis: a noninvasive, cost-effective, and widely available but underutilized diagnostic tool. Endocr Pract 2012; 18 (04) 567-578
- 2 Peng X, Wu S, Bie C, Tang H, Xiong Z, Tang S. Mean peak systolic velocity of superior thyroid artery for the differential diagnosis of thyrotoxicosis: a diagnostic meta-analysis. BMC Endocr Disord 2019; 19 (01) 56
- 3 Kurita S, Sakurai M, Kita Y. et al. Measurement of thyroid blood flow area is useful for diagnosing the cause of thyrotoxicosis. Thyroid 2005; 15 (11) 1249-1252
- 4 Zuhur SS, Ozel A, Kuzu I. et al. The diagnostic utility of color doppler ultrasonography, Tc-99m pertechnetate uptake, and tsh-receptor antibody for differential diagnosis of Graves’ disease and silent thyroiditis: A comparative study. Endocr Pract 2014; 20 (04) 310-319
- 5 Vitti P, Rago T, Mazzeo S. et al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis. J Endocrinol Invest 1995; 18 (11) 857-861
- 6 Bahn Chair RS, Burch HB, Cooper DS. et al. American Thyroid Association; American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21 (06) 593-646
- 7 Hari Kumar KV, Pasupuleti V, Jayaraman M, Abhyuday V, Rayudu B R, Modi KD. Role of thyroid Doppler in differential diagnosis of thyrotoxicosis. Endocr Pract 2009; 15 (01) 6-9
- 8 Uchida T, Takeno K, Goto M. et al. Superior thyroid artery mean peak systolic velocity for the diagnosis of thyrotoxicosis in Japanese patients. Endocr J 2010; 57 (05) 439-443
- 9 Karakas O, Karakas E, Cullu N. et al. An evaluation of thyrotoxic autoimmune thyroiditis patients with triplex Doppler ultrasonography. Clin Imaging 2014; 38 (01) 1-5
- 10 Zhao X, Chen L, Li L. et al. Peak systolic velocity of superior thyroid artery for the differential diagnosis of thyrotoxicosis. PLoS One 2012; 7 (11) e50051
- 11 Chen L, Zhao X, Liu H. et al. Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J Int Med Res 2012; 40 (02) 640-647
- 12 Kim TK, Lee EJ. The value of the mean peak systolic velocity of the superior thyroidal artery in the differential diagnosis of thyrotoxicosis. Ultrasonography 2015; 34 (04) 292-296
- 13 Hiraiwa T, Tsujimoto N, Tanimoto K, Terasaki J, Amino N, Hanafusa T. Use of color Doppler ultrasonography to measure thyroid blood flow and differentiate graves’ disease from painless thyroiditis. Eur Thyroid J 2013; 2 (02) 120-126
- 14 Sundarram KT, Sadacharan D, Ravikumar K, Kalpana S, Suresh RV. Role of color Doppler ultrasonography in differentiation of graves’ disease from thyroiditis: A prospective study. World J Endoc Surg 2017; 9: 41-45
- 15 Yoshimura Noh J, Momotani N, Fukada S, Ito K, Miyauchi A, Amino N. Ratio of serum free triiodothyronine to free thyroxine in Graves’ hyperthyroidism and thyrotoxicosis caused by painless thyroiditis. Endocr J 2005; 52 (05) 537-542
- 16 Izumi Y, Hidaka Y, Tada H. et al. Simple and practical parameters for differentiation between destruction-induced thyrotoxicosis and Graves’ thyrotoxicosis. Clin Endocrinol (Oxf 2002; 57 (01) 51-58
- 17 Chen X, Zhou Y, Zhou M, Yin Q, Wang S. Diagnostic values of free triiodothyronine and free thyroxine and the ratio of free triiodothyronine to free thyroxine in thyrotoxicosis. Int J Endocrinol 2018; 2018: 4836736
- 18 Sriphrapradang C, Bhasipol A. Differentiating Graves’ disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine. Ann Med Surg (Lond 2016; 10: 69-72
- 19 Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N. TSH receptor autoantibody immunoassay in patients with Graves’ disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev 2012; 12 (02) 107-113