The Value Of Dynamic Observing The Ultrasound Features Of Hashimoto's Thyroiditis In Different Clinical Types

Objective: To discover the value of ultrasonography in Hashimoto'sthyroiditis (HT) progresses, through dynamic observing the ultrasoundfeatures in different clinical types and in different periods. There is few reportat present. Ultrasound can not only discover the minimal changes in thethyroid, but also can describe the lesions of the image blood flow distributionand hemodynamic parameters. Therefore, the comprehensive analysis theseultrasound parameters can provide guidance for diagnose the disease andclinical treatment to the patients. From color Doppler ultrasonography in apreliminary diagnosis of thyroid disease, to ultrasound-guided biopsytechnology and the interventional therapy of the ultrasound, the use ofultrasound is playing a positive role and has important clinical value to thethyroid disease diagnosis and treatment.The paper devotes to discuss the sonographic characteristics ofHashimoto's thyroiditis in different clinical types and in different periods,through dynamic observing the changes of ultrasound and the comparison thesize, the echogenicity characteristics, the blood flow distribution and thesuperior thyroid artery's hemodynamic parameters. Thus, it shows that, as anoninvasive checking method, Color Doppler ultrasound can be used to assessand monitor thyroid function of the patients of Hashimoto's thyroiditis to acertain extent, it can provide more reference for the clinical diagnosis. It alsocan provide valuable imaging information for patients to accept the correcttreatment in time, avoiding misdiagnosis and the pains of operation.Methods: The study Selects90patients with Hashimoto's thyroiditisfrom the endocrine division and glands surgery division of the second hospital of Hebei Medical University. All the patients have been gotten clinicaldiagnosis through clinical symptoms, our nuclear laboratory examination andclinical treatment (excluding the diseases that effect thyroid function, such ashypothalamus disease, pituitary disease, adrenal disease, and the liver diseaseand so on). According to the thyroid function, the90patients are divided intothree groups: the HT patients with hyperthyroidism, the HT patients witheuthyroidism, and the HT patients with hypothyroidism. The HT patients withhyperthyroidism and the HT patients with hypothyroidism are given clinicalconventional treatments. In the same period, the study Selects30healthyvolunteers as a normal control group.The experiment instrument Philips IU22color Doppler ultrasounddiagnostic apparatus uses high-frequency probe (the frequency of5~12MHz). The sampling volume is about1.0mm. The color gain is transferred tono clutter interference, sound beam and blood flow in the direction of beamangle≤60°.The patients are admitted supine position, raise head back to thelater slightly, and fully expose neck. Conventional line horizontally andvertically and oblique scanning, at two-dimensional ultrasound condition,measure the length, width, thickness of bilateral leaves and the thickness ofisthmus of thyroid gland, then measure the diameter of the superior thyroidartery, and then observe the thyroid shape, echogenicity, quality of a material,and presence of nodules, measuring the nodules size; Color Doppler flowimaging observes the blood flow distribution of thyroid gland, using the visualgrading evaluation method divide the thyroid blood distribution into0, Ⅰ, Ⅱ,Ⅲ four ranks; Spectral Doppler measure the hemodynamic parameters of thesuperior thyroid artery, including maximum velocity (Vmax), resistance index(RI) and observe spectral characteristics, do the detailed record. Repeatmeasure the three groups of patients with Hashimoto's thyroiditis after3months,6months respectively.The SPSS13.0statistical software is used to conduct statistical analysisof the data obtained. Measurement data is shown in the way of mean±standard deviation (x±s), multiple comparisons is tested with analysis of variance and F test, paired comparison with q test. Qualitative data is analysisof chi-square test. It is a statistical significance when P <0.05.Results:1. The length, width, thickness of bilateral leaves and the thickness ofisthmus is different between four groups of patients. The thickness of bilateralleaves and isthmus of the three groups of Hashimoto's thyroiditis is biggerthan normal control group. There are significant differences of the thickness ofbilateral leaves between the three groups of Hashimoto's thyroiditis. Thethickness of bilateral leaves in the HT patients with hyperthyroidism is biggerthan other groups. Normal control group ultrasound images show that bothsides of the thyroid are symmetry, shape rule, capsular complete and smooth,middle echogenicity and small light points in glands. In the HT patients withhyperthyroidism and the HT patients with euthyroidism, the echogenicity ismainly diffuse reduce, regional flakiness reduce, In the HT patients withhypothyroidism, there are mainly diffuse reduce with fiber echoes or noduleslikely echoes in the thyroid.2. The blood flow range of the thyroid is different in each group. In thenormal control group, the blood flow of the thyroid is not abundant, showingsparse distribution of points and fascicular blood flow signals. In the HTpatients with hyperthyroidism, the blood flow of the thyroid is mainlyⅡ leveland Ⅲ level. In the HT patients with euthyroidism, the blood flow of thethyroid is mainly0level andⅠlevel. In the HT patients with hypothyroidism,all the blood flow of0level, Ⅰ level, Ⅱ level, Ⅲ level can be seen.3. The diameter of the superior thyroid artery is different in each group;the difference between the HT patients with hyperthyroidism and others isstatistically significant. The maximum velocity of superior thyroid artery isdifferent in each group; the difference is statistically significant between theHT patients with hyperthyroidism and others, between the HT patients withhypothyroidism and others. The resistance index of the three groups ofHashimoto's thyroiditis is higher than normal control group. The spectralcharacteristics of Normal control group is low speed and low resistance, The spectral characteristics of the HT patients with hypothyroidism and the HTpatients with euthyroidism also are low speed and low resistance, butcompared with Normal control group, the spectrum peaks is more dull,systolic maximum velocity is higher, diastolic maximum velocity flow downmore slowly and evenly, The diameter of the superior thyroid artery of someHT patients with hyperthyroidism can be wider than2mm, the spectrumpeaks is more dull, systolic maximum velocity is higher, diastolic maximumvelocity flow down more fast.4. The HT patients with hyperthyroidism T3, T4in tend to be normal,only TSH level still slightly lower than normal after6months. The numbers ofthe original echo reduce area increases gradually, the change of honeycombingis more evident, and the blood flow in the thyroid is less than before. The echoof the HT patients with hypothyroidism is more bulky, reduced, disorder, theecho of the nodular structure in tend to owe even after3months and6months.It can be seen that a small amount of irregular low echo in some cases, and allthe blood flow in the thyroid is less than before. The resistance index ofsuperior thyroid artery have higher trend as the disease progresses.5. The maximum velocity of superior thyroid artery and the thyroidstimulating hormone levels are positive correlation. The maximum velocity ofsuperior thyroid artery increase with the thyroid stimulating hormone levelheighten, reduce with the thyroid stimulating hormone bring down.Conclusion:1. The thickness of bilateral leaves and isthmus of the three groups ofHashimoto's thyroiditis is bigger than normal control group. The thickness ofbilateral leaves in the HT patients with hyperthyroidism is bigger than othergroups. In the HT patients with hyperthyroidism and the HT patients witheuthyroidism, the echogenicity is mainly diffuse reduce, regional flakinessreduce, In the HT patients with hypothyroidism, there are mainly diffusereduce with fiber echoes or nodules likely echoes in the thyroid.2. In the HT patients with hyperthyroidism, the blood flow of the thyroidis mainlyⅡ level and Ⅲ level. In the HT patients with euthyroidism, the blood flow of the thyroid is mainly0level andⅠlevel. In the HT patients withhypothyroidism, all the blood flow of0level, Ⅰ level, Ⅱ level, Ⅲ levelcan be seen.3. The diameter of the superior artery of the thyroid is wider and thesystolic maximum velocity is higher in the HT patients with hyperthyroidismthan the other three groups. The difference is statistically significant betweenthe HT patients with hypothyroidism and others. The resistance index of thethree groups of Hashimoto's thyroiditis is higher than normal control group.4. In the HT patients with hyperthyroidism, The numbers of the originalecho reduce area increases gradually after6months, The echo of the HTpatients with hypothyroidism is more bulky, reduced, disorder, the echo of thenodular structure in tend to owe even after3months and6months. It can beseen that a small amount of irregular low echo in some cases, and all the bloodflow in the thyroid is less than before in the three groups. The resistance indexof superior thyroid artery have higher trend as the disease progresses.5. The maximum velocity of superior thyroid artery and the thyroidstimulating hormone levels are positive correlation.