Thyroid vascularity and blood flow are not dependent on serum thyroid hormone levels: studies in vivo by color flow doppler sonography

Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, University of Pisa, Pisa, Italy.

OBJECTIVE: Thyroid blood flow is greatly enhanced in untreated Graves' disease, but it is not known whether it is due to thyroid hormone excess or to thyroid hyperstimulation by TSH-receptor antibody. To address this issue in vivo patients with different thyroid disorders were submitted to color flow doppler sonography (CFDS). SUBJECTS AND METHODS: We investigated 24 normal subjects, and 78 patients with untreated hyperthyroidism (49 with Graves' hyperthyroidism, 24 with toxic adenoma, and 5 patients with TSH-secreting pituitary adenoma (TSHoma)), 19 patients with thyrotoxicosis (7 with thyrotoxicosis factitia, and 12 with subacute thyroiditis), 37 euthyroid patients with goitrous Hashimoto's thyroiditis, and 21 untreated hypothyroid patients with Hashimoto's thyroiditis. RESULTS: Normal subjects had CFDS pattern 0 (absent or minimal intraparenchimal spots) and mean intraparenchimal peak systolic velocity (PSV) of 4.8+/-1.2cm/s. Patients with spontaneous hyperthyroidism due to Graves' disease, TSHoma, and toxic adenoma had significantly increased PSV (P<0.0001, P=0.0004, P<0.0001 respectively vs controls) and CFDS pattern. Patients with Graves' disease had CFDS pattern II (mild increase of color flow doppler signal) in 10 (20%) and pattern III (marked increase) in 39 cases (80%). Mean PSV was 15+/-3cm/s. Patients with toxic adenoma had CFDS pattern I (presence of parenchymal blood flow with patchy uneven distribution) in 2 (8%), pattern II in 16 (70%) and pattern III in 5 (22%). Mean PSV was 11+/-2.4cm/s. Patients with TSHoma showed CFDS pattern I in one case (20%) and pattern II in 4 (80%). Mean PSV was 14.8+/-4.2cm/s. Patients with thyrotoxicosis had normal PSV (4.2+/-1. 1cm/s in subacute thyroiditis, 4+/-0.8cm/s in thyrotoxicosis factitia, P=not significant vs controls) and CFDS pattern 0. Untreated euthyroid patients with goitrous Hashimoto's thyroiditis had CFDS pattern 0, and mean PSV (4.3+/-0.9cm/s; P=not significant vs controls). Untreated hypothyroid patients with goitrous Hashimoto's thyroiditis had CFDS pattern I in 14 cases (67%), pattern II in 4 (19%) and pattern 0 in 3 (14%) and mean PSV (5.6+/-1. 4cm/s) was higher than that of controls (P=0.026). CONCLUSIONS: An increase in both intrathyroidal vascularity and blood velocity was observed in patients with spontaneous hyperthyroidism but not in thyrotoxicosis due to either ingestion of thyroid hormones or to a thyroidal destructive process. The slightly increased vascularity and blood velocity observed in patients with hypothyroid Hashimoto's thyroiditis suggests that thyroid stimulation by either TSH-receptor antibody or TSH is responsible for the increased thyroid blood flow.

This article has been cited by other articles:

				T A A Macedo, M C Chammas, P T Jorge, L Pereira de Souza, L Farage, B L Pegoraro, S U Pessa, and G G Cerri Reference values for Doppler ultrasound parameters of the thyroid in a healthy iodine-non-deficient population Br. J. Radiol., August 1, 2007; 80(956): 625 - 630. [Abstract] [Full Text] [PDF]

				Y. Erbil, Y. Ozluk, M. Giris, A. Salmaslioglu, H. Issever, U. Barbaros, Y. Kapran, S. Ozarmagan, and S. Tezelman Effect of Lugol Solution on Thyroid Gland Blood Flow and Microvessel Density in the Patients with Graves' Disease J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 2182 - 2189. [Abstract] [Full Text] [PDF]

				J. Tajiri Radioactive Iodine Therapy for Goitrous Hashimoto's Thyroiditis J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4497 - 4500. [Abstract] [Full Text] [PDF]

				S.-M. Huang, N.-H. Chow, H.-L. Lee, and T.-J. Wu The Value of Color Flow Doppler Ultrasonography of the Superior Thyroid Artery in the Surgical Management of Graves Disease Arch Surg, February 1, 2003; 138(2): 146 - 151. [Abstract] [Full Text] [PDF]