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

Abstract

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.

Keywords

• Hipertiroidizm
• doppler ultrasonografi
• pik sistolik hız

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

Abstract

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.

Keywords

• Hyperthyroidism
• doppler ultrasonography
• Peak systolic velocity

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