Enhancing Diagnostic Accuracy: The Significance of Color Doppler Imaging Sonography in Thyrotoxicosis Differential Diagnosis

Abstract

Background and Objectives: The primary culprits behind thyrotoxicosis are either
autoimmune-mediated hyperactivity of the thyroid gland, as seen in Graves' disease, or
inflammation-induced thyroiditis, including subacute thyroiditis and postpartum thyroiditis.
Accurate diagnosis is crucial due to the distinct management approaches based on the
underlying cause. While RAIU-radioactive iodine uptake by Thyroid and technetium
pertechnetate (99mTc) thyroid scan are considered gold standards, their limited availability
and high cost necessitate exploration of alternative diagnostic parameters for
hyperthyroidism. This study aimed to assess the diagnostic usefulness of Non-invasive
thyroid color flow doppler sonography (CFDS) for distinguishing different etiologies of
thyrotoxicosis. Materials and Methods: 146 newly diagnosed thyrotoxicosis patients were
included. Depending on clinical examination, laboratory parameters, and thyroid scans,
patients were categorized in Graves' disease or thyroiditis groups. CFDS assessments were
conducted in radiology department. Results: 109 cases were diagnosed with Graves' disease,
while 37 with thyroiditis. The average peak systolic velocity (PSV) in inferior thyroid artery
(ITA) from both thyroid lobes served as indicators of thyroid vascularity. Statistical analysis
revealed a significant difference in mean PSV-ITA among Graves' disease vs. thyroiditis
cases. ROC analysis demonstrated that a PSV cut-off values of 51 cm/s exhibited 99.2%
sensitivity and 97.3% specificity in distinguishing Graves' disease vs. thyroiditis, along with
positive and negative predictive values of 98% and 97%, respectively. Conclusion: Noninvasive CFDS, characterized by its affordability and accessibility, offers insights into the
functionality of thyroid gland. The PSV measurements in ITA present a valuable tool for
distinguishing the causes of thyrotoxicosis.