The role of the resistive index in Hashimoto's thyroiditis: a sonographic pilot study in children

Abstract

Objective: The role of Doppler ultrasonography in the diagnosis of diffuse thyroid diseases is not well established. In particular, Doppler ultrasonography findings in children with Hashimoto's thyroiditis are very limited. We examined gray-scale and Doppler ultrasound findings in Hashimoto's thyroiditis in children in an attempt to understand the feasibility of future prospective controlled studies.

Materials and methods: Twenty-one children with newly diagnosed Hashimoto's thyroiditis were recruited in the study. The patients were euthyroid or had subclinical hypothyroidism at the time of the ultrasonography examination. According to the color Doppler scale developed by Schulz et al., thyroid glands were classified into four patterns based on visual scoring and the mean resistive index (RI), which was calculated via measurements from both lobes, and these results were compared with gray-scale findings.

Results: The mean RI value, calculated as the mean of the RI values of both lobes obtained from each patient, was found to be 0.57 ± 0.05 (range 0.48-0.67) cm/sn. The distribution of thyroid classifications was as follows: Pattern 0, n = 7; Pattern I, n = 6; Pattern II, n = 4; and Pattern III ("thyroid inferno"), n = 4. The mean RI values in patients with normal or near-normal gray-scale findings (n = 10) and patients with more substantial gray-scale changes (n = 11) were not significantly different and were lower than the values in normal children previously presented in the literature.

Conclusion: The results indicated that the RI may be more sensitive than other ultrasound parameters for the diagnosis of Hashimoto's thyroiditis.

Figure 1

Gray-scale grading. Grades 1-4 are shown in a-d, respectively. Grade 0, representing a completely normal thyroid gland, is not shown in this figure.

Figure 2

Color Doppler patterns. a. Pattern 0 (normal thyroid vascularity); b. color Doppler Pattern I (minimally increased thyroid vascularity); c. color Doppler Pattern II (increased blood flow with a diffuse homogenous distribution); and d. color Doppler Pattern III (“thyroid inferno”).