Thyroid sonography as an extension of the bedside examination in hyperthyroidism

Angelos Kyriacou; Panayiotis A Economides; Akheel A Syed

doi:10.20883/medical.e482

Authors

Angelos Kyriacou CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus; Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK https://orcid.org/0000-0003-2282-0192
Panayiotis A Economides School of Medicine, European University Cyprus, Nicosia, Cyprus https://orcid.org/0000-0002-5504-5113
Akheel A Syed Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK https://orcid.org/0000-0001-8696-7121

DOI:

https://doi.org/10.20883/medical.e482

Keywords:

hyperthyroidism, graves, sonography, ultrasound, point-of-care

Abstract

In this mini-review, we discuss the role of thyroid sonography as a ‘point-of-care’ tool for assessing and managing patients with (suspected) hyperthyroidism who present to the endocrine outpatient clinic. A thyroid ultrasound may aid in distinguishing between hyperthyroidism and destructive thyroiditis. The presence of intense vascularity (‘thyroid inferno’) on the power Doppler has a very high positive predictive value in identifying hyperthyroidism. It may also allow for the sub-classification of hyperthyroidism into autoimmune and nodular hyperthyroidism. It is important to identify the presence of thyroid nodules at an early stage, as this may influence management. Toxic nodules requires definitive treatment, as well as the presence of nodules in Graves’ disease because of increased risk of malignancy. Current guidelines on hyperthyroidism do not clearly state thyroid sonography as a first line investigation, although recent authoritative reviews point in that direction. Given the aforementioned benefits of thyroid sonography, alongside the reduced costs and widespread availability of high-resolution (including portable) ultrasound devices, there is an argument for thyroid sonography to be applied as a first line investigation for all patients with hyperthyroidism. Endocrinologists trained in thyroid sonography could perform this as an extension of their clinical examination when patients first present with hyperthyroidism at the endocrine clinic.

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References

Bell L, Hunter AL, Kyriacou A, Mukherjee A, Syed AA. Clinical diagnosis of Graves’ or non-Graves’ hyperthyroidism compared to TSH receptor antibody test. Endocrine Connections. 2018 Apr;7(4):504-510. https://doi.org/10.1530/ec-18-0082

Kharchenko V, Kotlyarov P, Mogutov M, Alexandrov Y, Sencha A, Patrunov Y, Belyaev D, eds. Ultrasound diagnostics of thyroid diseases. First edit. Springer-Verlag Berlin Heidelberg; 2010.

Scappaticcio L, Trimboli P, Keller F, Imperiali M, Piccardo A, Giovanella L. Diagnostic testing for Graves' or non‐Graves' hyperthyroidism: A comparison of two thyrotropin receptor antibody immunoassays with thyroid scintigraphy and ultrasonography. Clinical Endocrinology. 2019 Dec 5;92(2):169-178. https://doi.org/10.1111/cen.14130

Baskin H, Duick D, Levine R, eds. Thyroid ultrasound and ultrasound-guided FNA. Third edition. Springer; 2013.

Kurita S, Sakurai M, Kita Y, Ota T, Ando H, Kaneko S, Takamura T. Measurement of Thyroid Blood Flow Area Is Useful for Diagnosing the Cause of Thyrotoxicosis. Thyroid. 2005 Nov;15(11):1249-1252. https://doi.org/10.1089/thy.2005.15.1249

Uchida T, Takeno K, Goto M, Kanno R, Kubo S, Takahashi S, Azuma K, Sakai K, Fujitani Y, Hirose T, Kawamori R, Watada H. Superior thyroid artery mean peak systolic velocity for the diagnosis of thyrotoxicosis in Japanese patients. Endocrine Journal. 2010;57(5):439-443. https://doi.org/10.1507/endocrj.k09e-263

Kumar KH, Pasupuleti V, Jayaraman M, Abhyuday V, Ramasubba Rayudu B, Modi KD. Role of Thyroid Doppler in Differential Diagnosis of Thyrotoxicosis. Endocrine Practice. 2009 10.1111/j.1365-2265.2007.02832.x1;15(1):6-9. https://doi.org/10.4158/ep.15.1.6

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. Clinical Endocrinology. 2007 Jul;67(1):41-45. https://doi.org/10.1111/j.1365-2265.2007.02832.x

Matthews DC, Syed AA. The role of TSH receptor antibodies in the management of Graves' disease. European Journal of Internal Medicine. 2011 Jun;22(3):213-216. https://doi.org/10.1016/j.ejim.2011.02.006

Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. https://doi.org/10.1089/thy.2016.0229

Toursarkissian B, Sloan DA, Schwartz RW. Coexisting hyperthyroidism and primary hyperparathyroidism. Surgery. 1993 Jun;113(6):716-8. PMID 8506532

Wei S, Baloch ZW, LiVolsi VA. Parathyroid Adenoma in Patients with Graves’ Disease: a Report of 21 Cases. Endocrine Pathology. 2014 Dec 13;26(1):71-74. https://doi.org/10.1007/s12022-014-9349-0

Hadjisavva IS, Dina R, Talias MA, Economides PA. Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status. European Thyroid Journal. 2015;4(2):123-128. https://doi.org/10.1159/000430438

Papanastasiou A, Sapalidis K, Goulis DG, Michalopoulos N, Mareti E, Mantalovas S, Kesisoglou I. Thyroid nodules as a risk factor for thyroid cancer in patients with Graves’ disease: A systematic review and meta‐analysis of observational studies in surgically treated patients. Clinical Endocrinology. 2019 Aug 13;91(4):571-577. https://doi.org/10.1111/cen.14069

Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. https://doi.org/10.1089/thy.2015.0020

Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. Journal of the American College of Radiology. 2015 Dec;12(12):1272-1279. https://doi.org/10.1016/j.jacr.2015.07.011

Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Journal of the American College of Radiology. 2017 May;14(5):587-595. https://doi.org/10.1016/j.jacr.2017.01.046

Russ G, Bonnema S, Erdogan M, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. European Thyroid Journal. 2017;6(5):225-237. https://doi.org/10.1159/000478927

Tam AA, Kaya C, Kılıç FBM, Ersoy R, Çakır B. Thyroid nodules and thyroid cancer in Graves’ disease. Arquivos Brasileiros de Endocrinologia & Metabologia. 2014 Dec;58(9):933-938. https://doi.org/10.1590/0004-2730000003569

Chen Y, Lin C, Chang Y, Cheng FT, Peng C, Sung F, Cheng Y, Kao C. Cancer Risk in Patients with Graves' Disease: A Nationwide Cohort Study. Thyroid. 2013 Jul;23(7):879-884. https://doi.org/10.1089/thy.2012.0568

Boutzios G, Vasileiadis I, Zapanti E, Charitoudis G, Karakostas E, Ieromonachou P, Karatzas T. Higher Incidence of Tall Cell Variant of Papillary Thyroid Carcinoma in Graves' Disease. Thyroid. 2014 Feb;24(2):347-354. https://doi.org/10.1089/thy.2013.0133

Preece J, Grodski S, Yeung M, Bailey M, Serpell J. Thyrotoxicosis does not protect against incidental papillary thyroid cancer. Surgery. 2014 Nov;156(5):1153-1156. https://doi.org/10.1016/j.surg.2014.04.025

Fu H, Cheng L, Jin Y, Chen L. Thyrotoxicosis with concomitant thyroid cancer. Endocrine-Related Cancer. 2019 Jul;26(7):R395-R413. https://doi.org/10.1530/erc-19-0129

Eaton SEM, Euinton HA, Newman CM, Weetman AP, Bennet WM. Clinical experience of amiodarone-induced thyrotoxicosis over a 3-year period: role of colour-flow Doppler sonography*. Clinical Endocrinology. 2002 Jan;56(1):33-38. https://doi.org/10.1046/j.0300-0664.2001.01457.x

Kyriacou A, McLaughlin J, Syed AA. Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review. European Journal of Internal Medicine. 2015 Oct;26(8):563-571. https://doi.org/10.1016/j.ejim.2015.07.017

Iyer PC, Cabanillas ME, Waguespack SG, Hu MI, Thosani S, Lavis VR, Busaidy NL, Subudhi SK, Diab A, Dadu R. Immune-Related Thyroiditis with Immune Checkpoint Inhibitors. Thyroid. 2018 Oct;28(10):1243-1251. https://doi.org/10.1089/thy.2018.0116

Pariani N, Willis M, Muller I, Healy S, Nasser T, McGowan A, Lyons G, Jones J, Chatterjee K, Dayan C, Robertson N, Coles A, Moran C. Alemtuzumab-Induced Thyroid Dysfunction Exhibits Distinctive Clinical and Immunological Features. The Journal of Clinical Endocrinology & Metabolism. 2018 Jun 6;103(8):3010-3018. https://doi.org/10.1210/jc.2018-00359

Varadhan L, Varughese G, Sankaranarayanan S. Hyperthyroidism and Graves' disease: Is an ultrasound examination needed?. Indian Journal of Endocrinology and Metabolism. 2016;20(6):866. https://doi.org/10.4103/2230-8210.192899

Goichot B, Bouée S, Castello-Bridoux C, Caron P. Survey of Clinical Practice Patterns in the Management of 992 Hyperthyroid Patients in France. European Thyroid Journal. 2017;6(3):152-159. https://doi.org/10.1159/000453260

Negro R, Attanasio R, Grimaldi F, Guglielmi R, Papini E. A 2015 Italian Survey of Clinical Practice Patterns in the Management of Graves' Disease: Comparison with European and North American Surveys. European Thyroid Journal. 2016;5(2):112-119. https://doi.org/10.1159/000444482

Matthews DC, Syed AA. The role of TSH receptor antibodies in the management of Graves' disease. European Journal of Internal Medicine. 2011 Jun;22(3):213-216. https://doi.org/10.1016/j.ejim.2011.02.006

Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, Eckstein AK, Stagnaro-Green A, Kahaly GJ. Graves’ disease. Nature Reviews Disease Primers. 2020 Jul 2;6(1). https://doi.org/10.1038/s41572-020-0184-y