Color-flow Doppler sonography in Graves disease: "thyroid inferno"

Abstract

Graves disease is a common diffuse abnormality of the thyroid gland usually characterized by thyrotoxicosis. We performed color-flow Doppler sonography in 16 patients with Graves disease and compared the results with those in 15 normal volunteers and 14 patients with other thyroid diseases (eight with multinodular goiter, four with focal masses, and two with papillary thyroid carcinoma). All 16 Graves disease patients exhibited a pulsatile pattern we call "thyroid inferno." This pattern consists of multiple small areas of intrathyroidal flow seen diffusely throughout the gland in both systole and diastole. In systole, both high-velocity flow (color coded white) and lower velocity flow (color coded red and blue) were noted. In diastole, fewer areas of flow and lower velocity flow were noted. Patients with Graves disease also exhibited color flow around the periphery of the gland. The inferno pattern did not occur in normal subjects or in patients with other thyroid diseases. On occasion, focal areas of intrathyroidal flow were detected in patients with multinodular goiter and focal thyroid masses. High-resolution gray-scale images did not show the small vascular channels from which the flow signal originated. Color-flow Doppler sonography shows promise as a cost-effective, noninvasive technique for diagnosing Graves disease.