J Korean Soc Radiol.  2016 Sep;75(3):177-184. 10.3348/jksr.2016.75.3.177.

Sonographic Decreased Echogenicity of Thyroid Parenchyma in Asymptomatic Population: Correlation with Thyroid Function and Thyroid Autoimmune Activity

• Park JY
• Park NH
• Park CS
• Lee JY
• Chun KA
• Yi SY
• Park HJ

• KMID: 2349322
• DOI: http://doi.org/10.3348/jksr.2016.75.3.177

Abstract

PURPOSE
The aim of the study was to evaluate the correlation between decreased echogenicity of thyroid and thyroid hormones or autoantibodies.
MATERIALS AND METHODS
From January 2009 to December 2011, 543 patients with decreased parenchymal echogenicity [M:F = 133:410, median age: 42 years (range: 9-82 years)], who did not have solid nodule, symptom or medication related to thyroid and underwent thyroid function test were retrospectively reviewed. Images were classified based on the degree of hypoechogenicity, heterogenicity or thyroid size. 1) Group A: mild decreased echogenicity, group B: marked decreased echogenicity, 2) group Ho: homogeneous echogenicity, group He: heterogeneous echogenicity, 3) group 1: decreased size, group 2: normal size, group 3: increased size. Differences in triiodiothyronyne (T3), free-thyroxine (fT4), thyrotropin (TSH), anti-thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), and anti-TSH receptor antibody (TSH-rAb) were evaluated among groups.
RESULTS
T3, fT4, and TSH levels differed between groups A and B (p < 0.001, p = 0.001, p < 0.001). TgAb and TPOAb of group B were higher than group A (p = 0.006, p < 0.001). TPOAb of group He was higher than group Ho (p < 0.001). TSH-rAb and TPOAb of group 3 were higher than group 2 (p = 0.017, p < 0.001).
CONCLUSION
The patients with findings of markedly decreased, heterogeneous echogenicity or thyroid enlargement may have abnormal thyroid function and autoantibodies. These may facilitate the physicians' decision to order tests for thyroid function and autoimmune activity.

MeSH Terms

Autoantibodies
Humans
Iodide Peroxidase
Retrospective Studies
Thyroid Function Tests
Thyroid Gland*
Thyroid Hormones
Thyrotropin
Ultrasonography*
Autoantibodies
Iodide Peroxidase
Thyroid Hormones
Thyrotropin

Figure

• 

  Fig. 1 Ultrasound (US) of group A and group B. A, B. US of group A shows mild decreased echogenicity (A) of thyroid, which is lower than the echogenicity of submandibular gland (B), but higher than that of strap muscle. C. US of group B shows the decreased echogenicity of thyroid, which is isoechoic to strap muscle.

• 

  Fig. 2 Ultrasound (US) of group Ho and group He. A. US of group Ho shows homogeneous decreased echogenicity of thyroid. B. US of group He shows multiple scattered tiny hypoechoic nodules in whole thyroid.

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  Fig. 3 Ultrasound (US) of group 1, 2, and 3. A. US of group 1 shows decreased size of thyroid. B. US of group 2 shows normal size of thyroid. C. US of group 3 shows increased size of thyroid.

Reference

1. Blum M, Goldman AB, Herskovic A, Hernberg J. Clinical applications of thyroid echography. N Engl J Med. 1972; 287:1164–1169.

2. Loy M, Cianchetti ME, Cardia F, Melis A, Boi F, Mariotti S. Correlation of computerized gray-scale sonographic findings with thyroid function and thyroid autoimmune activity in patients with Hashimoto's thyroiditis. J Clin Ultrasound. 2004; 32:136–140.

3. Schiemann U, Gellner R, Riemann B, Schierbaum G, Menzel J, Domschke W, et al. Standardized grey scale ultrasonography in Graves' disease: correlation to autoimmune activity. Eur J Endocrinol. 1999; 141:332–336.

4. Nordmeyer JP, Shafeh TA, Heckmann C. Thyroid sonography in autoimmune thyroiditis. A prospective study on 123 patients. Acta Endocrinol (Copenh). 1990; 122:391–395.

5. Hayashi N, Tamaki N, Konishi J, Yonekura Y, Senda M, Kasagi K, et al. Sonography of Hashimoto's thyroiditis. J Clin Ultrasound. 1986; 14:123–126.

6. Vitti P. Grey scale thyroid ultrasonography in the evaluation of patients with Graves' disease. Eur J Endocrinol. 2000; 142:22–24.

7. Raber W, Gessl A, Nowotny P, Vierhapper H. Thyroid ultrasound versus antithyroid peroxidase antibody determination: a cohort study of four hundred fifty-one subjects. Thyroid. 2002; 12:725–731.

8. Schiemann U, Avenhaus W, Konturek JW, Gellner R, Hengst K, Gross M. Relationship of clinical features and laboratory parameters to thyroid echogenicity measured by standardized grey scale ultrasonography in patients with Hashimoto's thyroiditis. Med Sci Monit. 2003; 9:MT13–MT17.

9. Mazziotti G, Sorvillo F, Iorio S, Carbone A, Romeo A, Piscopo M, et al. Grey-scale analysis allows a quantitative evaluation of thyroid echogenicity in the patients with Hashimoto's thyroiditis. Clin Endocrinol (Oxf). 2003; 59:223–229.

10. Rago T, Chiovato L, Grasso L, Pinchera A, Vitti P. Thyroid ultrasonography as a tool for detecting thyroid autoimmune diseases and predicting thyroid dsfunction in apparently healthy subjects. J Endocrinol Invest. 2001; 24:763–769.

11. Vejbjerg P, Knudsen N, Perrild H, Laurberg P, Pedersen IB, Rasmussen LB, et al. The association between hypoechogenicity or irregular echo pattern at thyroid ultrasonography and thyroid function in the general population. Eur J Endocrinol. 2006; 155:547–552.

12. Dvoráková M, Hill M, Cerovská J, Novák Z, Sterzl I. [Is decreased thyroid echogenity a good indicator of thyroid autoimmune disorder?]. Vnitr Lek. 2006; 52:900–905.

13. Chaudhary V, Bano S. Thyroid ultrasound. Indian J Endocrinol Metab. 2013; 17:219–227.

14. Solbiati L, Charboneau JW, Osti V, James EM, Hay ID. The thyroid gland. In : Rumack CM, Wilson SR, Charboneau JW, editors. Diagnostic ultrasound. St. Louis: Elsevier Mosby;2005. p. 735–770.

15. Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R, Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. J Clin Endocrinol Metab. 1991; 72:209–213.

16. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011; 21:593–646.

17. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012; 22:1200–1235.