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DOI: 10.1055/s-2004-821308
J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Prediction of Relapse after Antithyroid Drug Therapy of Graves' Disease: Value of Color Doppler Sonography
Publication History
Publication Date:
25 October 2004 (online)
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Abstract
Opinions differ regarding the indications for antithyroid drugs, radioiodine and surgery in patients with Graves' disease because the likelihood of long-term remission after medical treatment cannot be predicted. The aim of this study was to assess the value of quantifying thyroid blood flow in an attempt to predict outcome following withdrawal of antithyroid drug therapy.
Spectral Doppler recordings were obtained from the thyroid arteries in 24 patients with Graves' disease at the time of diagnosis. Thyroid blood flow levels measured at the time of diagnosis of Graves' disease were correlated with outcome following withdrawal of medical treatment (mean duration of treatment: 14 months). Clinical follow-up for at least 18 months (range: 18 - 39 months) after antithyroid drug withdrawal was possible in 13 patients (12 women).
Mean peak systolic velocity and volume flow rate values as well as thyroid volume measured at the time of diagnosis were significantly higher (139 cm/s, SD 46; 195 ml/min, SD 170; 52 ml, SD 18) in patients who relapsed after drug treatment compared with patients in remission (71 cm/s, SD 27; 67 ml/min, SD 61; 25 ml, SD 13). The correlation between thyroid blood flow measurements and thyroid volume was high (r = 0.79 - 0.96). Recurrence of disease could be predicted with a sensitivity of 71 % and a specificity of 100 % based on thyroid blood flow measurements.
This preliminary data suggest that quantification of thyroid blood flow by means of Doppler sonography might be a useful tool to predict the outcome of Graves' disease following withdrawal of medical treatment and could be helpful in finding the adequate kind of therapy.
Key words
Graves' disease - thyroid - Doppler studies
References
- 1 Baldini M I, Castagnone D, Rivolta R, Baldini M I, Tozzi R, Cantalamessa L. Thyroid vascularization by color Doppler ultrasonography in Graves' disease. Changes related to different phases and to the long-term outcome of the disease. Thyroid. 1997; 7 823-828
- 2 Bogazzi F, Bartalena L, Vitti P, Rago T, Brogioni S, Martino E. Color flow Doppler sonography in thyrotoxicosis factitia. J Endocrinol Invest. 1996; 19 603-606
- 3 Bogazzi F, Bartalena L, Brogioni S, Burelli A, Manetti L, Tanda M L, Gasperi M, Martino E. Thyroid vascularity and blood flow are not dependent on serum thyorid hormone levels: studies in vivo by color flow Doppler sonography. Eur J Endocrinol. 1999; 140 452-456
- 4 Castagnone D, Rivolta R, Rescalli S. et al . Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome. Am J Roentenol. 1996; 166 203-207
- 5 Hodgson K J, Lazarus J H, Wheeler M H, Woodcock J P, Owen G M, McGregor A, Hall R. Duplex scan-derived thyroid blood flow in euthyroid and hyperthyroid patients. World J Surg. 1988; 12 470-475
- 6 Saleh A, Fürst G, Feldkamp Godehardt J E, Grust A, Mödder U. Estimation of antithyroid drug dose in Graves' disease: value of quantification of thyroid blood flow with color duplex sonography. Ultrasound Med Biol. 2001; 27 1137-1141
- 7 Saleh A, Cohnen M, Fürst G, Godehardt E, Mödder U, Feldkamp J. Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves' disease and diffuse toxic goiter. Exp Clin Endocrinol Diab. 2002; 110 32-36
- 8 Schleusener H, Schwander J, Fischer C, Holle R, Holl G, Badenhoop K, Hensen J, Finke R, Bogner U, Mayr W R, Schernthaner G, Schatz H, Pickardt C R, Kotulla P. Prospective multicenter study on the prediction of relapse after antithyroid drug treatment in patients with Graves' disease. Acta Endocrinol. 1989; 120 689-701
- 9 Vitti P, Rago T, Chiovato L. Clinical features of patients with Graves' disease undergoing remission after antithyroid drug treatment. Thyroid. 1997; 7 369-375
- 10 Weetman A P. Graves' disease. N Engl J Med. 2000; 343 1236-1248
- 11 Woodcock J P, Owen G M, Shedden E J, Hodgson K J, MacGregor A, Srivastava A. Duplex scanning of the thyroid. Ultrasound Med Biol. 1985; 11 659-663
- 12 Zingrillo M, D'Aloiso L, Ghiggi M R, Di Cerbo A, Chiodini I, Torlontano M, Liuzzi A. Thyroid hypoechogenicity after methimazole withdrawal in Graves' disease: a useful index for predicting recurrence?. Clinical Endocrinol. 1996; 45 201-206
M. D. Andreas Saleh
Institute of Diagnostic Radiology
University Hospital Düsseldorf
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Germany
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Email: saleh@uni-duesseldorf.de