The Diagnostic Utility of Color Doppler Ultrasonography, Tc-99m Pertechnetate Uptake, and TSH-Receptor Antibody for Differential Diagnosis of Graves' Disease and Silent Thyroiditis: A Comparative Study.

OBJECTIVE The differential diagnosis of Graves disease (GD) and silent thyroiditis (ST) is important for the selection of appropriate treatment. To date, no study has compared the diagnostic utility of color Doppler ultrasonography (CDUSG), Tc-99m (technetium-99m) pertechnetate uptake, and thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) for the differential diagnosis of these two conditions. In the present study, we compared the diagnostic utility of inferior thyroid artery (ITA) peak systolic and end diastolic velocities (PSV and EDV) measured by CDUSG, Tc-99m pertechnetate uptake, and TRAb for differential diagnosis of GD and ST. METHODS A total of 150 subjects with GD, 79 with ST, and 71 healthy euthyroid controls were included in the study. Diagnoses of GD and ST were made according to patient signs and symptoms, physical examination findings, the results of TRAb and Tc-99m pertechnetate uptake, and follow-up findings. All subjects underwent CDUSG for the quantitative measurement of ITA blood-flow velocities. RESULTS The mean ITA-PSV and EDV in patients with GD were significantly higher than in ST patients. In receiver operating characteristic analysis, the sensitivity/specificity of the 30 and 13.2 cm/s cutoff values of the mean ITA-PSV and EDV for discrimination of GD from ST were 95.3/94.9% and 89.3/88.6%, respectively. The sensitivity/specificity of the 1.0 international unit (IU)/L and 3% cutoff values of the TRAb and Tc-99m pertechnetate uptake analyses were 93.0/91.0% and 90.7/89.9%, respectively. CONCLUSION The measurement of ITA-PSV by CDUSG is a useful diagnostic tool and is a complementary method to the TRAb and Tc-99m pertechnetate uptake methods for differential diagnosis of GD and ST.

[1]  J. Faber,et al.  Incidence rate of symptomatic painless thyroiditis presenting with thyrotoxicosis in Denmark as evaluated by consecutive thyroid scintigraphies , 2013, Scandinavian journal of clinical and laboratory investigation.

[2]  M. Vanderpump,et al.  Performance of a third‐generation TSH‐receptor antibody in a UK clinic , 2011, Clinical endocrinology.

[3]  J. Garber,et al.  Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. , 2011, Thyroid : official journal of the American Thyroid Association.

[4]  Kageumi Takeno,et al.  Superior thyroid artery mean peak systolic velocity for the diagnosis of thyrotoxicosis in Japanese patients. , 2010, Endocrine journal.

[5]  P. Laurberg,et al.  Assays for thyroid-stimulating hormone receptor antibodies employing different ligands and ligand partners may have similar sensitivity and specificity but are not interchangeable. , 2010, Thyroid : official journal of the American Thyroid Association.

[6]  K. Kamijo.  Study on cutoff value setting for differential diagnosis between Graves' disease and painless thyroiditis using the TRAb (Elecsys TRAb) measurement via the fully automated electrochemiluminescence immunoassay system. , 2010, Endocrine journal.

[7]  K. Hari Kumar,et al.  Role of thyroid Doppler in differential diagnosis of thyrotoxicosis. , 2009, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[8]  W. Scherbaum,et al.  Comparison of M22-based ELISA and human-TSH-receptor-based luminescence assay for the measurement of thyrotropin receptor antibodies in patients with thyroid diseases. , 2008, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[9]  P. Vitti,et al.  Could improved ultrasound and power Doppler replace thyroidal radioiodine uptake to assess thyroid disease? , 2007, Nature Clinical Practice Endocrinology &Metabolism.

[10]  A. Miyauchi,et al.  Quantitative measurement of thyroid blood flow for differentiation of painless thyroiditis from Graves’ disease , 2007, Clinical endocrinology.

[11]  M. Erdoğan,et al.  Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism. , 2007, Thyroid : official journal of the American Thyroid Association.

[12]  S. Kaneko,et al.  Measurement of thyroid blood flow area is useful for diagnosing the cause of thyrotoxicosis. , 2005, Thyroid : official journal of the American Thyroid Association.

[13]  M. Inaba,et al.  The significance of thyroid blood flow at the inferior thyroid artery as a predictor for early Graves’ disease relapse , 2005, Clinical endocrinology.

[14]  Megumi Tanaka,et al.  Clinical evaluation of 3rd generation assay for thyrotropin receptor antibodies: the M22-biotin-based ELISA initiated by Smith. , 2005, Endocrine journal.

[15]  M. Stazi,et al.  Postpartum thyroiditis is associated with fluctuations in transforming growth factor-beta1 serum levels. , 2003, The Journal of clinical endocrinology and metabolism.

[16]  M. Tambascia,et al.  Thyroid uptake and scintigraphy using 99mTc pertechnetate: standardization in normal individuals. , 2002, Sao Paulo medical journal = Revista paulista de medicina.

[17]  G. Fürst,et al.  Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter. , 2002, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[18]  J. Ramsden,et al.  Angiogenesis in the thyroid gland. , 2000, The Journal of endocrinology.

[19]  A. Nagata,et al.  Clinical significance of a sensitive assay for thyroid-stimulating antibodies in Graves' disease using polyethylene glycol at high concentrations and porcine thyroid cells. , 1999, Endocrine journal.

[20]  L Manetti,et al.  Thyroid vascularity and blood flow are not dependent on serum thyroid hormone levels: studies in vivo by color flow doppler sonography. , 1999, European journal of endocrinology.

[21]  B. Rapoport,et al.  The Thyrotropin (TSH)-Releasing Hormone Receptor: Interaction with TSH and Autoantibodies , 1998 .

[22]  M. Iitaka,et al.  Increased serum vascular endothelial growth factor levels and intrathyroidal vascular area in patients with Graves' disease and Hashimoto's thyroiditis. , 1998, The Journal of clinical endocrinology and metabolism.

[23]  W. Scherbaum,et al.  Application of a Bioassay with CHO Cells for the Routine Detection of Stimulating and Blocking Autoantibodies to the TSH-Receptor , 1998, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[24]  M. Baldini,et al.  Thyroid vascularization by color doppler ultrasonography in Graves' disease. Changes related to different phases and to the long-term outcome of the disease. , 1997, Thyroid : official journal of the American Thyroid Association.

[25]  E. Levin,et al.  Vasoactive Peptides Modulate Vascular Endothelial Cell Growth Factor Production and Endothelial Cell Proliferation and Invasion* , 1997, The Journal of Biological Chemistry.

[26]  C. Shigemasa,et al.  Pertechnetate thyroid uptake is not always suppressed in patients with subacute thyroiditis. , 1997, Clinical nuclear medicine.

[27]  M. Baldini,et al.  Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome. , 1996, AJR. American journal of roentgenology.

[28]  Elena S. Di Martino,et al.  Thyroid blood flow evaluation by color-flow doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis , 1995, Journal of endocrinological investigation.

[29]  P. Colman,et al.  Specific effects of radioiodine treatment on TSAb and TBAb levels in patients with Graves' disease. , 1995, Thyroid : official journal of the American Thyroid Association.

[30]  S. Fukata,et al.  Immunological findings and thyroid function of untreated Graves' disease patients with undetectable TSH‐binding inhibitor immunoglobulin , 1994, Clinical endocrinology.

[31]  K. Burman,et al.  Endothelin binding to receptors and endothelin production by human thyroid follicular cells: effects of transforming growth factor-beta and thyrotropin. , 1993, The Journal of clinical endocrinology and metabolism.

[32]  K. Kasagi,et al.  Thyrotoxic graves’ disease with normal thyroidal technetium-99m pertechnetate uptake , 1990, Annals of nuclear medicine.

[33]  G. Brent.  Graves' disease. , 2008, British medical journal.

[34]  P. Alderson,et al.  The role of 99mTc pertechnetate uptake in the evaluation of thyroid function. , 1983, International journal of nuclear medicine and biology.

[35]  M. Buse,et al.  The Anger Camera and the Pertechnetate Ion in the Routine Evaluation of Thyroid Uptake and Imaging , 1979, Clinical Nuclear Medicine.

[36]  P. Schneider.  Simple, rapid thyroid function testing with 99mTc-pertechnetate thyroid uptake ratio and neck/thigh ratio. , 1979, AJR. American journal of roentgenology.

[37]  T. K. Natarajan,et al.  Validation of a rapid computerized method of measuring 99mTc pertechnetate uptake for routine assessment of thyroid structure and function. , 1973, The Journal of clinical endocrinology and metabolism.