The value of real-time ultrasound elastography in chronic autoimmune thyroiditis
Authors: Menzilcioglu M S , Duymus M , Gungor G , Citil S , Sahin T , Boysan S N , Sarica A 
Published: October 2014

Objective:
Chronic autoimmune thyroiditis (CAT) (chronic lymphocytic thyroiditis—Hashimoto's thyroiditis), which is the most common inflammatory disorder of the thyroid gland, causes hypothyroidism. Ultrasound elastography is a newly developed sonographic technique that provides an estimation of tissue elasticity by measuring the degree of tissue displacement under the application of an external force. In this study, our aim was to evaluate the accuracy of strain index ratio with real-time ultrasound elastography and to calculate the cut-off point for the diagnosis of CAT. Our aim was also to lead further studies on other pathological changes such as lymphoma, malign nodules etc. based on CAT by using this cut-off point. The gains from this study and further studies will assist clinical diagnoses and follow-up.

Methods:
Aplio™ 500 ultrasound machine (Toshiba Medical Systems Co. Ltd, Otawara, Japan) with linear 4.8–11.0 MHz transducers and elastography software was used. Routine B-mode (dimensions and parenchymal echogenicity) ultrasound evaluation was performed prior to the ultrasound elastography.

Results:
A total of 31 randomized patients (3 males, 28 females) with a mean age of 39.13 ± 10.16 years (range, 16–58 years) with CAT and 21 healthy controls (6 males, 15 females) with mean age of 34.67 ± 16.31 years (range, 14–81 years) were prospectively examined. The mean values of thyroid-stimulating hormone (TSH; normal TSH value is 0.27–4.20 IU ml−1) and anti-thyroid peroxidase (anti-TPO; normal anti-TPO value is 0–34 IU ml−1) were 3.40 ± 2.70 and 373.66 ± 148.94 IU ml−1, respectively. No correlation was detected between serum TSH and thyroid tissue strain index (Spearman r coefficient of TSH was −0.290). Positive-sided correlation was detected between anti-TPO values and thyroid tissue strain index ratio (Spearman r coefficient of anti-TPO was 0.682). The median strain index ratio of patients with CAT (1.39 ± 0.72) was significantly higher than the mean ratio of the controls (0.76 ± 0.55). The area under the receiver operating characteristic curve was 0.775 (95% confidence interval). The optimal cut-off value (in which the sum of sensitivity and specificity was highest) for the prediction of diffuse thyroid pathology was 0.677. For this cut-off ratio, thyroid stiffness had 96% sensitivity and 67% specificity. A total of 30 of 31 patients (96%) and a total of 7 of 21 healthy controls (33%) exceeded the cut-off points.

Conclusion:
The strain index ratio was higher in CAT than in normal thyroid parenchyma in real-time ultrasound elastography. Thus, it seems to be a useful method for the assessment of CAT with real-time ultrasound elastography, and further studies assessing the correlation of sonoelastography findings and histopathological subtypes of CAT would enrich the findings of the present study.

Advances in knowledge:
In our study, we detected the stiffness ratio of the thyroid tissue in patients with CAT. The cut-off value should be helpful for diagnosis or follow-up of the recently developed lesions such as lymphoma, malign nodule, etc. based on CAT. This study should also encourage new studies about CAT and ultrasound elastography.