SONOWORLD : Diffuse thyroiditis

Username

Password

187,853 Registered Members as of 07/30/2021.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Thyroid/parathyroid » General

Diffuse thyroiditis

« Back to Listing

Author(s) :

Chaitali Shah, FRCR

Pamela T. Johnson, MD

Presentation A 25 year old femae presents with a one week history of a tender midline swelling of the neck. She also had complaints of palpitations and fine tremors of the hand. Laboratory features revealed increased levels of T3 and T4 and decreased TSH level.

Caption: Transverse sonogram of the neck.

Description: Transverse sonogram reveals a heterogeneous and coarse echotexture of the enlarged thyroid gland.

Caption: Sagittal view of right lobe of thyroid.

Description: Sagittal view of the enlarged right thyroid reveals a coarse and heterogeneous echotexture. No focal mass is identified.

Caption: Sagittal view of the left lobe of thyroid.

Description: Sagittal view of the enlarged left thyroid also reveals a coarse and heterogeneous echotexture. No focal mass is identified.

Caption: Color Doppler study of the right lobe of thyroid.

Description: Color Doppler view showing increased vascularity of the right lobe.

Caption: Color Doppler view of left thyroid gland.

Description: Color Doppler view showing increased vascularity in the left lobe of the thyroid gland.

Differential Diagnosis Diffuse thyroiditis

Final Diagnosis Diffuse thyroiditis

Discussion Thyroiditis is the most common group of inflammatory disorders affecting the thyroid gland and is encountered very often in clinical practice. Thyroiditis can be painful or painless. The suggested classification of thyroiditis is acute, subacute and chronic. Acute thyroiditis usually has a bacterial etiology and can be very painful. Subacute thyroiditis usually presents with a transient hyperthyroidism followed by hypothyroidism and they encompass two distinct varieties. The lymphocytic kind, which is silent [has an unknown pathogenesis or is autoimmune] or the granulomatous kind, which is painful [and typically has a viral etiology]. The chronic lymphocytic type of thyroiditis is Hashimotos and it is known to have an autoimmune basis. Graves' disease and Hashimotos thyroiditis are the most commonly encountered thyroid disorders.

A diffuse or multifocal decrease in echogenicity demonstrated on ultrasound is the hallmark of many types of thyroiditis. This decrease in echogenicity may be due to an increase in the intrathyroidal blood flow, increased cellularity of the thyroid follicles with decreased colloid production and or lymphocytic infiltration. On color and power Doppler studies, increased blood flow is noted throughout the gland. This constellation of findings of reduced echogenicity of the gland with an increased vascularity is highly suggestive of a diffuse thyroiditis. In addition, the gland is often heterogeneous.

Return of the normal thyroid echogenicity and blood flow is noted on resolution of the disease. However heterogeneity may persist if the chronic thyroiditis ensues [fibrosis may set in within the gland, resulting in a coarsened echotexture].

Radioactive iodine uptake testing can aid in identifying the various etiologies of hyperthyroidism and also help in patient selection for I-131 treatment.

Case References 1.Arslan H, et al. Power Doppler sonography in the diagnosis of Graves' disease. Eur J Ultrasound. 2000 May 11(2): 117-22.
2.Vitti P, et al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves' disease from Hashimoto's thyroiditis.J Endoc Invest. 1995 Dec 18(11): 857-61.
3.Vitti P, et al. Thyroiditis: clinical aspects and diagnostic imaging. Rays. 1999 Apr-Jun; 24(2): 301-14.
4.Singer PA. Thyroiditis. Acute, subacute, and chronic. Med Clin North Am. 1991 Jan; 75(1): 61-77.
5.Niedziela M, et al. Thyroid echogeneity as a useful tool for the differential diagnosis of hyperthyroidism in the course of Graves disease and Hashimoto thyroiditis. Endokrynol Diabet 2000; 6(2): 143-50.
6.Aydin O et al. Cytological correlation in patients who have a pre-diagnosis of thyroiditis ultrasonographically. Endocrine Research. 29(1):97-106, 2003 Feb.
7.Hamburger JI. The various presentations of thyroiditis.Ann Intern Med. 1986 Feb; 104(2): 219-24

Follow Up No histopathology was available, however a follow up ultrasound demonstrated a normal sized thyroid gland with homogeneous echotexture, concurring that the patient had an episode of subacute viral thyroiditis.

Other contents by this AuthorOther Cases in This Category

Thyroid/parathyroid >> General

Parathyroid adenoma
A 55 year old female presents with complaints of gastroesophageal reflux, crampy abdominal pain, depression and osteoporosis. Laboratory results showed a persistently elevated PTH levels.

Papillary carcinoma of the thyroid with cervical nodal metastases
A 25 year old woman presented with firm right lateral neck swelling. She also had a six pound weight loss over a period of one month. An ultrasound of the neck was performed.

Papillary carcinoma of the thyroid
A 57 year old woman with left thyroid lobe enlargement. An ultrasound of the neck was performed.

Submandibular duct calculus
A young woman presented with pain in the right submandibular region. The patient said she could palpate something in her mouth since her pain had started.

Acute parotitis in a child
A 3-year-old girl presented with a very painful swollen right side of her face and neck and fever. This was the first episode. An ultrasound was performed.

Left parathyroid adenomas
A potential kidney donor was detected to have asymptomatic hypercalcemia. An ultrasound of the neck was performed.

Neonatal hyperthyroidism
This is the ultrasound scan of the neck in an infant with a history of maternal hyperthyroidism.

Right parathyroid adenoma
A young man presents with painless swelling on the right side of the neck of 15 days duration. An ultrasound of the neck was performed.

Submandibular gland sialolithiasis
A 9-year-old girl presents with recurrent painful swelling in the region of the left submandibular gland. On examination there was tender swelling with no signs of local inflammation. A focused ...

Parotid abscess with reactive lymphadenitis
This is the scan in a young kid with fever and a painful swelling of the right side of the face. She was treated with a 5-day- course of oral antibiotics; however there was minimal clinical ...

Parathyroid Adenoma causing medullary neprhocalcinosis
A 39 years old woman presents at the clinic suffering from bone and abdominal pains. The patient has been diagnosed as having osteoporosis.

Subacute Granulomatous Thyroiditis, de Quervain's thyroiditis
A 39-year-old man presents with acute onset of pain in the thyroid region, exacerbated by turning the head swallowing. The pain radiates to the jaw.

Malignant Melanoma Metastasis to Parotid Gland
A 79-year-old with a history of cutaneous melanoma of the head is referred for ultrasound examination for bilateral swelling of the parotid glands.

Hashimoto's Thyroiditis
A 31 years old female presents overweight, fatigue, constipation and dry skin. Laboratory features revealed increased levels of TSH, decreased levels of T3, T4 and increased levels of TPO anti. A ...