Elastography in the differential diagnosis of thyroid nodules in Hashimoto thyroiditis

Elastography is a method which assesses the risk of the malignancy and provides information about the degree of hardness in tissue. Hashimoto’s thyroiditis, autoimmune lymphocytic infiltration and fibrosis, is considered to be a very common disease that is able to change the hardness of the tissue. The diagnostic value of elastography of this group of patients has not previously been reported. In our study, we aimed to determine the diagnostic value of elastography in 283 patients (255 female, 28 male) with Hashimoto’s thyroiditis. Elastography score and index were measured with real-time ultrasound elastography (Hitachi^® EUB 7000 HV machine with using 13 MHz linear transducer). The outcome of this measure shows that malignant nodules were with higher elastography scores (ES) and strain indexes (SI) values. ES ≥3 were observed in 16/20 malignant and 130/263 benign nodules, respectively. The area under the curve (AUC) for the elasto score (AUC) was 0.72 (p = 0.001), and AUC for the strain index was 0.77 (p < 0.0001). Accordingly, our study suggests that strain index reflects malignancy better than the elasto score. We conclude that elastography score is ≥3 providing 80 % sensitivity and 50 %, six specificity for diagnosing malignancy. For strain index, we found that 2.45 (72.2 % sensitivity and 70 % specificity) is a cut-off point. We have detected a lower cut-off point for SI in Hashimoto patients although sensitivity and specificity decreases in Hashimoto in this population.