Süperior Tiroidal Arter Doppler Bulgularının Hipertiroidizm Ayırıcı Tanısında Rolü Var mı?

Yıl 2020, , 47 - 52, 19.08.2020

Tugba Eldes , Arzu Turan , Fatma Beyazal Celiker Metin Celiker , Mehmet Beyazal , Ertan Zengin Teslime Ayaz Mehmet Masum Simsek

https://doi.org/10.46332/aemj.782764

Öz

Amaç: Hipertiroidinin erken tanı ve doğru tedavisi, ilişkili sistemik komplikasyonları önleyebilmek açısından önemlidir. Ayırıcı tanıda serum tiroid hormonları, tiroid otoantikorları ve radyoaktif iyot uptake sintigrafisi kullanılmakta ancak bu incelemelerle kesin tanıya gidilememektedir. Çalışmamızda laboratuar bulgularının yanında süperior tiroidal arterin dublex doppler ultrason bulgularının tanıya katkısını değerlendirdik. Bu doppler bulgularının, gri scala ultrasonografi bulgularına ek destekleyici bir yöntem olabileceğini göstermeyi amaçladık. Araçlar ve Yöntem: Çalışmaya 75’i kadın ve 21’i erkek olmak üzere toplam 96 kişi dahil edildi. Hipertiroidili gruplar graves hastalığı (GD) ve toksik multınoduler guatrı olan (TMNG); sırasıyla 29 ve 41 kişiydi. Kontrol grubu olarak çalışmaya ötiroid 26 kişi dahil edildi. Tüm bireylere yapılan dublex doppler ultrason ile süperior tiroidal arterlerinin pik sistolik hız, end diastolik hız ve rezistivite index değerlerine bakıldı. Pik sistolik değerlerinin toksik multinodüler guatr grubunda gravefs hastalarına göre anlamlı yüksek olduğu bulundu. Bulgular: TMNG and GD hastalarında, pik sistolik hız, diyastol sonu hız ve rezistif index değerleri kontrol grubuna göre anlamlı yüksek bulundu (p<0.001). TMNG ve GD hastaları karşılaştırıldığında ise sadece pik sistolik hız değeri TMNG’li grup lehine anlamlı yüksek bulundu. TMNG‘li grubun ( 50.5±26.5 cm/sec) ve GD’li (34.2±11.5 cm/sec) grubun pik sistoli hız değerleri klinik tanı anında karşılaştırıldı. Sonuç: Hipertiroidi ayırıcı tanısında sintigrafinin gerekli olduğu yerlerde süperior tiroidal arterin pik sistolik hız değerlerinin kullanılabileceği kanaatindeyiz. Böylece alınabilecek potansiyel radyasyon dozu ve kaybedilecek zaman önlenebilir.

Anahtar Kelimeler

Hipertiroidizm, doppler ultrasonografi, pik sistolik hız

Do Superior Thyroidal Artery Doppler Findings Play a Role in the Differential Diagnosis of Hyperthyroidism?

Öz

Purpose: Early diagnosis and treatment of hyperthyroidism are important to prevent associated systemic complications. Serum thyroid hormones, thyroid autoantibodies, and radioactive iodine uptake scintigraphy are used in diagnosis; but these investigations do not lead to a definitive diagnosis. In our study, we evaluated the contribution of the findings observed on duplex doppler ultrasonography of the superior thyroidal artery to the diagnosis in addition to laboratory findings. Our aim was to show whether these findings could be alternatives to scintigraphy when scintigraphy is indicated. Material and Methods: The study included 96 individuals consisting of 75 women and 21 men. Hyperthyroidism group included 29 and 41 patients with Graves’ disease (GD) and toxic multinodular goiter (TMNG), respectively. 26 euthyroid individuals were also included in the study as a control group. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistivity index (RI) values of superior thyroidal arteries were analyzed with duplex doppler ultrasonography. Results: For PSV, EDV and RI values were significantly higher in patients with hyperthyroidism compared to the control group (p<0.001). PSV value was found statistically significantly higher in the TMNG group (50.5±26.5 cm/sec) when compared to the untreated GD group (34.2±11.5 cm/sec) at the initial clinical presentation. Conclusion: We believe that the PSV of the superior thyroidal artery can be used for the differential diagnosis of hyperthyroidism when scintigraphy is indicated. Thus, the potential dose of radiation received can be lowered and the loss of time can be prevented.

Anahtar Kelimeler

Hyperthyroidism, doppler ultrasonography, Peak systolic velocity

Kaynakça

• 1. Hari Kumar KS, Pasupuleti V, Jayaraman M, et al. Role of thyroid Doppler in differential diagnosis of thyrotoxicosis. Endocr Prac. 2009;15(1):6-9.
• 2. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-1421.
• 3. Boi F, Loy M, Piga M, et al. The usefulness of conventional and echo colour Doppler sonography in the differential diagnosis of toxic multinodular goitres. Eur J Endocrinol. 2000;143(3):339-346.
• 4. Turkish Society of Endocrinology and Metabolism. Guideline for diagnosis and treatment of thyroid diseases 2017. http://temd.org.tr/admin/uploads/tbl_kilavuz/20180518105146-2018-05-18tbl_kilavuz105136.pdf . 2017:84-85. Accessed on 19/05/2018.
• 5. Erdogan MF, Anil C, Cesur M, et al. Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism. Thyroid. 2007;17(3):223-228.
• 6. Hari Kumar KV, Vamsikrishna P, Verma A, et al. Evaluation of thyrotoxicosis during pregnancy with color flow Doppler sonography. Int J Gynaecol Obstet. 2008;102(2):152-155.
• 7. Caruso G, Attard M, Caronia A, et al. Color Doppler measurement of blood flow in the inferior thyroid artery in patients with autoimmune thyroid diseases. Eur J Radiol. 2000;36(1):5-10.
• 8. Bogazzi F, Vitti P. Could improved ultrasound and power Doppler replace thyroidal radioiodine uptake to assess thyroid disease? Nat Clin Pract Endocrinol Metab. 2008;4(2):70-71.
• 9. Vitti P, Rago T, Mazzeo S, et al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis. J Endocrinol Invest. 1995;18(11):857-861.
• 10. Becker D, Bair HJ, Becker W, et al. Thyroid autonomy with color-coded image-directed Doppler sonography: internal hypervaskularization for the recognition of autonomous adenomas. J Clin Ultrasound. 1997;25(2):63-69.
• 11. Berghout A, Wiersinga WM, Smits NJ, et al. Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic nontoxic goiter. Am J Med. 1990;89(5):602-608.
• 12. Gozu HI, Lublinghoff J, Bircan R, et al. Genetics and phenomics of inherited and sporadic non-autoimmune hyperthyroidism. Mol Cell Endocrinol. 2010;322(1-2):125-134.
• 13. Mazzaferri EL. Thyroid cancer and Graves’ disease. J Clin Endocrinol Metab. 1990;70(4):826-829.
• 14. Kawai K, Tamai H, Mori T, et al. Thyroid histology of hyperthyroid Graves’disease with undetectable thyrotropin receptors antibodies. J Clin Endocrinol Metab. 1993;77(3):716-719.
• 15. Clark KJ, Cronan JJ, Scola FH. Color Doppler sonography: anatomic and physiologic assesment of the thyroid. J Clin Ultrasound. 1995;23(4):215-223.
• 16. Summaria V, Salvatori M, Rufini V, et al. Diagnostic imaging in thyrotoxicosis. Rays. 1999;24(2):273-300.
• 17. Hiraiwa T, Tsujimoto N, Tanimoto K, et al. Use of Color Doppler Ultrasonography to Measure Thyroid Blood Flow and Differentiate Graves’ Disease from Painless Thyroiditis. Eur Thyroid J. 2013;2(2):120-126.
• 18. Kim TK, Lee EJ. The value of the mean peak systolic velocity of the superior thyroidal artery in the differential diagnosis of thyrotoxicosis. Ultrasonography. 2015;34(4):292-296.
• 19. Chen L, Zhao X, Liu H, et al. Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J Int Med Res. 2012;40(2):640-647.
• 20. Karakas O, Karakas E, Cullu N, et al. An evaluation of thyrotoxic autoimmune thyroiditis patients with triplex Doppler ultrasonography. Clin Imaging. 2014;38(1):1-5.
• 21. Uchida T, Takeno K, Goto M, et al. Superior thyroid artery mean peak systolic velocity for the diagnosis of thyrotoxicosis in Japanese patients. Endocr J. 2010;57(5):439-443.
• 22. Zhao X, Chen L, Li L, et al. Peak Systolic Velocity of Superior Thyroid Artery for the Differential Diagnosis of Thyrotoxicosis. PLoS One. 2012;7(11):7-12.
• 23. Banaka I, Thomas D, Kaltsas G. Value of the left inferior thyroid artery peak systolic velocity in diagnosing autoimmune thyroid disease. J Ultrasound Med. 2013;32(11):1969-1978.
• 24.Donkol RH, Nada AM, Boughattas S. Role of color doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis. World J Radiol. 2013;5(4):178-183.