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Exp Clin Endocrinol Diabetes 2002; 110(1): 32-36
DOI: 10.1055/s-2002-19992
Articles

© Johann Ambrosius Barth

Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter

A. Saleh 1 , M. Cohnen 1 , G. Fürst 1 , E. Godehardt 3 , U. Mödder 1 , J. Feldkamp 2
  • 1 Institute of Diagnostic Radiology, University Hospital Düsseldorf, Germany
  • 2 Department of Endocrinology, University Hospital Düsseldorf, Germany
  • 3 Biometric Research Group, Clinic of Thoracic and Cardiovascular Surgery, University Hospital Düsseldorf, Germany
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Publication History

received 03 April 2001 first decision 26 June 2001

received 27 July 2001

Publication Date:
07 February 2002 (online)

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Summary

The aim of our study was to evaluate the usefulness of color duplex sonography to distinguish Graves' disease from diffuse toxic goiter. 24 patients with Graves' disease and 13 patients with diffuse toxic goiter underwent B-mode- and color duplex sonography of the thyroid gland. All patients had hyperthyroidism and elevated 99mTc-uptake. Spectral Doppler recordings were obtained at all thyroid arteries. Representative color flow maps of the thyroid gland were analyzed, calculating the percentage area of the thyroid gland, occupied by color pixels (color pixel density). The B-mode ultrasound pattern was subjectively assessed on a 4-point rating scale. In patients with Graves' disease the mean peak systolic velocity (PSV) (SD) was 110 (± 49) cm/s, the mean volume flow rate (VFR) was 123 ( ± 67) ml/min and the mean color pixel density (CPD) was 33 (± 12) %. For patients with diffuse toxic goiter mean PSV (SD) was 43 ( ± 9) cm/s (p < 0.001), mean VFR was 23 (± 10) ml/min (p < 0.001) and mean CPD was 9 (± 6) % (p = 0.007). CPD and spectral duplex recordings were positively correlated (CPD/PSV: rs = 0.77, CPD/VFR: rs = 0.75; p < 0.0001). No significant differences were observed concerning RI values. Sensitivity was 87% and specificity 92% for CPD and VFR and 87% and 100% for PSV. We conclude, that color duplex sonography can reliably distinguish diffuse toxic goiter from Graves' disease and therefore contributes significantly to the differential diagnosis of hyperthyroidism in diffuse thyroid disease.

Key words:

Graves' disease - Disseminated autonomy - Antibody-negative hyperthyroidism - Color Doppler sonography - Hyperthyroidism - Vascularity

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MD Andreas Saleh

Institute of Diagnostic Radiology

University Hospital Duesseldorf

Moorenstr. 5

D-40225 Düsseldorf

Germany

Phone: +49 211-811-7752

Fax: +49 211-811-6145

Email: saleh@uni-duesseldorf.de

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