Journal List > Korean J Endocr Surg > v.11(2) > 1060053

M.D., M.D., M.D., M.D., and M.D.: Sonographic Analysis of the Nodular Form of Hashimoto Thyroiditis

Abstract

Purpose:

There are relatively few results from studies on nodular Hashimoto's thyroiditis. In addition, some Hashimoto's thyroiditis patients present with irregular symptoms, making the distinction from malignant thyroid nodule difficult. Therefore, we performed analyses on ultrasonographic findings of nodular Hashimoto's thyroiditis.

Methods:

A retrospective follow-up study was performed on 76 patients (88 nodules) diagnosed with Hashimoto's thyroiditis after undergoing fine needle aspiration biopsy from January 2009 to December 2010. A frequency analysis was performed to investigate the most common ultrasonographic findings of nodular Hashimoto's thyroiditis. In addition, patients were divided into two groups based on the presence or absence of extensive Hashimoto's thyroiditis on the parenchyma, and ultrasonographic findings were compared and analyzed for nodules in each group.

Results:

The study was performed on 76 patients and 88 nodules. The majority of nodular Hashimoto's thyroiditis were found to be solid on ultrasonography, and echogenicity was mostly hypoechoic, with prominent hypoechoic findings being more common. Most nodules did not have a rim surrounding the margins, and absence of accompanying calcification was also noted. The comparison and analysis of ultrasonographic findings of two patient groups that were divided based on the presence or absence of Hashimoto's thyroiditis across the parenchyma, revealed no significant difference.

Conclusion:

Most nodular Hashimoto's thyroiditis cases do not present with calcification or rims and frequently present as solid and hypoechoic. It can be concluded that such findings are consistent regardless of whether there is accompanying extensive changes at the thyroid parenchyma associated with Hashimoto's thyroiditis.

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Table 1.
Sonographic features of nodular Hashimoto thyroiditis
Nodule characteristics Number (%)
Solid vs Cystic Solid 85 (96.6)
Cystic 3 (3.4)
Echogenecity Hyperechoic 5 (5.7)
Isoechoic 19 (21.6)
Mild hypoechoic 28 (31.8)
Maked hypoechoic 36 (40.9)
Echotexture Homogenous 51 (58.0)
Heterogenous 37 (42.0)
Halo None 74 (84.1)
Complete regular 14 (15.9)
Nodule characteristics Number (%)
Calcification None 73 (83.0)
Microcalcification 13 (14.7)
Eggshell calcification 2 (2.3)
Margin Well defined 45 (51.1)
Ill defined 43 (48.9)
Shape Regular 38 (43.2)
Irregular 50 (56.8)
Doppler Hypervascular 38 (43.2)
No flow 50 (56.8)
Height vs Wide Width 75 (85.2)
Height 13 (14.8)
Fig. 1
55 year old woman with nodular Hashimoto thyroiditis. Transverse scan shows well defined solid hypoechoic nodule. Background parenchyma is homogenous.
kjes-11-75f1.tif
Fig. 2
52 year old women with nodular Hashimoto thyroiditis. Transverse scan show well defined oval shaped solid hypoechoic nodule. Background parenchyma is heterogenous and coarse echotexture.
kjes-11-75f2.tif
Table 2.
Comparison of sonographic features of nodular Hashimoto thyroiditis with and without diffuse background parenchymal Hashimoto thyroiditis
Nodule characteristics % of Nodules (No./Total No.) with
Nodular HT With Background HT Nodular HT without Background HT P-value
Solid vs Cystic      
Solid 92.6 (50/52) 97.2 (35/36) 0.786
Cystic 3.8 (2/52) 2.8 (1/36)  
Echogenecity      
Hyperechoic 7.7 (4/52) 2.8 (1/36) 0.217
Isoechoic 26.9 (14/52) 13.9 (5/36)  
Mild hypoechoic 25.0 (13/52) 41.7 (15/36)  
Maked hypoechoic 40.4 (21/52) 41.7 (15/36)  
Echotexture      
Homogenous 53.8 (28/52) 63.9 (23/36) 0.348
Heterogenous 46.2 (24/52) 36.1 (13/36)  
Halo      
None 76.9 (40/52) 94.4 (34/36) 0.083
Complete regular 23.1 (12/52) 5.6 (2/36)  
Calcification      
None 82.7 (43/52) 83.3 (30/36) 0.615
Microcalcification 15.4 (8/52) 13.9 (5/36)  
Eggshell calcification 1.9 (1/52) 2.8 (1/36)  
Margin      
Well defined 46.2 (24/52) 58.3 (21/36) 0.261
Ill defined 53.8 (28/52) 41.7 (15/36)  
Shape      
Regular 36.5 (19/52) 52.8 (19/36) 0.131
Irregular 63.5 (33/52) 47.2 (17/36)  
Doppler      
Hypervascular 40.4 (21/52) 47.2 (17/36) 0.532
No flow 59.6 (31/52) 52.8 (19/36)  
Height vs Wide      
Width 82.7 (43/52) 88.9 (32/36) 0.421
Height 17.3 (9/52) 11.1 (4/36)  
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