Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jun;2(2):120-6.
doi: 10.1159/000350560. Epub 2013 May 15.

Use of color Doppler ultrasonography to measure thyroid blood flow and differentiate graves' disease from painless thyroiditis

Tetsuya Hiraiwa  1 , Naoyuki Tsujimoto  2 , Keiji Tanimoto  2 , Jungo Terasaki  2 , Nobuyuki Amino  3 , Toshiaki Hanafusa  2
Affiliations

Use of color Doppler ultrasonography to measure thyroid blood flow and differentiate graves' disease from painless thyroiditis

Tetsuya Hiraiwa et al. Eur Thyroid J. 2013 Jun.

Abstract

Backgrounds: Color Doppler ultrasonography (CDU) has not yet been established as a method to investigate the pathogenesis of thyrotoxicosis.

Objectives: Our first objective was to determine whether the measurement of peak systolic blood-flow velocity in the superior thyroid artery (STV) and thyroid tissue blood flow (TBF) using CDU could differentiate Graves' disease (GD) from painless thyroiditis (PT). The second objective was to examine the factors mediating increased blood flow to the thyroid gland in GD.

Methods: Recruited patients had untreated GD or PT and visited the Department of Internal Medicine (I), Osaka Medical College, between April 1, 2006 and May 31, 2010. Age, gender, blood pressure, pulse rate, thyroid-stimulating hormone, free thyroxine, tri-iodothyronine, TSH receptor antibody and thyroid volume were evaluated in patients. In addition, bilateral measurements of STV, TBF and peak systolic velocity in the common carotid artery (CCV) were also performed. TBF was quantified by calculating the ratio of blood-flow pixels to total pixels in the region of interest using sagittal section images of the thyroid gland. Receiver-operating characteristic curve analysis was performed to determine the ability of STV and TBF measurements to differentiate GD from PT.

Results: For the average of STV measured on both sides, the area under the receiver-operating characteristic curve (AUC) was 0.956. For the average of TBF measured on both sides, the AUC was 0.920. At an average STV cut-off value of 43 cm/s, the sensitivity to discriminate GD from PT was 0.87 and the specificity was 1.00. At an average TBF cut-off value of 3.8%, the sensitivity was 0.71 and the specificity was 1.00. In the GD group, neither blood pressure nor pulse rate correlated with the average STV or TBF. Moreover, there was no correlation between STV and CCV or between TBF and CCV on either side. However, STV was correlated with TBF (right side: R = 0.47; left side: R = 0.52).

Conclusions: The results demonstrate that STV and TBF are useful for differentiating GD from PT. Furthermore, the increased STV and TBF found in GD are not related to hyperthyroidism-induced increases in systolic blood pressure, pulse rate or CCV.

Keywords: Color Doppler ultrasonography; Graves’ disease; Painless thyroiditis; Superior thyroid artery; Thyroid blood flow.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a Measurement of peak systolic velocity of the STV. b TBF was calculated on a sagittal image of the right thyroid lobe.
Fig. 2
Fig. 2
a ROC curve analysis using the average STV to differentially diagnose GD and PT. b ROC assessment of the ability to differentially diagnose GD and PT by average TBF.
See this image and copyright information in PMC

References

    1. Ralls PW, Mayekawa DS, Lee KP, Colletti PM, Radin DR, Boswell WD, Halls JM. Color-flow Doppler sonography in Graves' disease: ‘thyroid inferno’. Am J Roentgenol. 1988;150:781–784. - PubMed
    1. Bogazzi F, Bartalena L, Brogioni S, Burelli A, Manetti L, Tanda ML, Gasperi M, Martino E. Thyroid vascularity and blood flow are not dependent on serum thyroid hormone levels: studies in vivo by color flow Doppler sonography. Eur J Endocrinol. 1999;140:452–456. - PubMed
    1. Ota H, Amino N, Morita S, Kobayashi K, Kubota S, Fukata S, Kamiyama N, Miyauchi A. Quantitative measurement of thyroid blood flow for differentiation of painless thyroiditis from Graves' disease. Clin Endocrinol. 2007;67:41–45. - PubMed
    1. Ueda M, Inaba M, Kumeda Y, Nagasaki T, Hiura Y, Tahara H, Onoda N, Ishikawa T, Nishizawa Y. The significance of thyroid blood flow at the inferior thyroid artery as a predictor for early Graves' disease relapse. Clin Endocrinol. 2005;63:657–662. - PubMed
    1. Hiraiwa T, Hanafusa T. Diagnostic approach to thyroid diseases. Progress in ultrasonography of the thyroid and its application (in Japanese) Nihon Naika Gakkai Zasshi. 2010;99:726–732. - PubMed