Elsevier

Clinical Imaging

Volume 49, May–June 2018, Pages 187-192
Clinical Imaging

The value of shear wave elastography in diffuse thyroid disease

https://doi.org/10.1016/j.clinimag.2018.03.019Get rights and content

Highlights

  • Shear wave™ elastography aids in the diagnosis of diffuse thyroid disease.

  • Shear wave™ elastography is superior to the fT3/fT4 ratio for distinguishing Graves' disease from subacute thyroiditis.

  • Thyroid stiffness cannot currently be used to predict thyroid function.

Abstract

Purpose

The aim of this study is to discuss the value of ultrasound-based shear wave™ elastography (SWE) in diffuse thyroid disease (DTD).

Method

Thyroid stiffness in 154 patients with DTD and 30 normal subjects was measured by SWE. The serum indicators of all subjects were detected.

Results

The area under the receiver operating characteristic (AUROC) curve for DTD by SWE was 0.852. The AUROCs of SWE for differentiating chronic autoimmune thyroiditis (CAT) from Graves' disease (GD) and subacute thyroiditis (SAT) were 0.549 and 0.989, respectively. The AUROCs for distinguishing GD from SAT by SWE and the fT3/fT4 ratio were 0.975 and 0.713, respectively.

Conclusion

SWE aids in the diagnosis of DTD, and SWE is superior to the fT3/fT4 ratio for distinguishing GD from SAT. However, SWE was unsuitable for differentiating CAT from GD.

Introduction

Diffuse thyroid disease (DTD) mainly includes chronic autoimmune thyroiditis (CAT) (chronic lymphocytic thyroiditis-Hashimoto's thyroiditis), Graves' disease (GD), and subacute thyroiditis (SAT). Both CAT and GD are autoimmune diseases related to genetic factors [1,2]. The common complication of CAT is hypothyroidism [3], and the most serious complication is thyroid lymphoma [4]. SAT is a self-limited inflammatory disease of the thyroid caused by virus infection. SAT can cause increases in free triiodothyronine (fT3), free thyroxine (fT4), the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) [5,6]. Given that the treatment and prognosis of CAT, GD and SAT are completely different, it is important to distinguish the three diseases. Currently, such diseases are mainly diagnosed based on clinical manifestations and laboratory indicators. Although conventional ultrasonography has auxiliary diagnostic value, the ultrasonic appearance of the three diseases overlap at times [7,8].

Ultrasonic elastography is a new technology that can evaluate the stiffness of the tissue. Currently, most studies on ultrasonic elastography of the thyroid focus on the differential diagnosis of benignancy and malignancy of thyroid nodules [[9], [10], [11]]. Fewer studies evaluate DTD using ultrasonic elastography. Menzilcioglu et al. [12] reported that real-time elastography (RTE) can effectively evaluate CAT. However, the parameter obtained from RTE is the ratio of the strain index of the thyroid lesion tissue to that of the normal surrounding thyroid tissues, and the tissue stiffness around the thyroid will affect the accuracy of the measurement results.

Shear wave™ elastography (SWE) is a new elastography technique applied to clinical practice in recent years. SWE was developed by Supersonic Imagine (France). The probe induces tissues to produce shear waves by transmitting a sound pulse. The propagation speed of the shear wave is measured through ultra-speed ultrasonic scanning and converted to kPa; thus, a quantified parameter can be obtained [13]. The purpose of this prospective study is to discuss the value of two-dimensional SWE in diagnosing DTD.

Section snippets

Patients

The Ethics Committee of Baoji Central Hospital approved this study. In total, 154 patients with diffuse thyroid disease were admitted to our endocrinology outpatient clinic for work-up at Baoji Central Hospital from October 2015 to November 2016. The patients were 41.0 ± 12.5 years old (range: 13–74 years old). The patient group included 76 patients with CAT, 40 patients with GD and 38 patients with SAT.

CAT inclusion criteria: The diagnosis of CAT is based on clinical and laboratory findings,

Results

Patients with diffuse thyroid disease included 38 male patients with a mean age of 42.0 ± 12.3 years (range, 13–74 years) and 116 female patients with a mean age of 36.8 ± 10.5 years (range, 16–55). The parameters of the thyroid function of the patients and normal subjects are presented in Table 1. Among the 76 patients with CAT, 35 patients had normal thyroid function, 29 patients had subclinical hypothyroidism (TSH increased), and 12 patients had hypothyroidism (TSH increased, and fT3 and fT4

Discussion

Thyroid function can be assessed through serological examination. However, different thyroid diseases can alter thyroid function; hence, it is relatively difficult to identify the cause of diffuse thyroid disease. Nuclear medicine examination (RAIU) can differentiate GD from SAT. However, this technique has little value in diagnosing Hashimoto's thyroiditis. In addition, although nuclear medicine is not an invasive test, its involves radiation. High-frequency ultrasonography is an important

Conflict of interest

The authors have no conflicts of interest to declare.

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