Presentation
Hyperthyroidism
Patient Data
Both lobes of the thyroid and isthmus are bulky in size and appear heterogeneously hypoechoic in echotexture with a marked diffuse increase in vascularity (thyroid inferno) on colour flow Doppler interrogation. The peak systolic velocity in the inferior thyroid artery is approximately 100-120 cm/sec.
A well-defined round solid iso to a hyperechoic lesion of size ~18.5 × 14.5 mm at the upper pole of the right lobe of the thyroid with no evidence of macro or microcalcification within it, likely adenomatous nodule (TI-RADS3 lesion).
TSH receptor antibody was highly positive.
Case Discussion
In patients with hyperthyroidism, above ultrasound findings, and high positive TSH receptor antibody suggest Graves disease.
The increased vascularity in the thyroid gland can be seen in the graves disease as well as in the thyroiditis. But in these situations, the peak systolic velocity in the inferior thyroid artery has a very important role in differentiating between them. The peak systolic velocity in the inferior thyroid artery in Graves disease is usually more than 60-70 cm/sec whereas it is less than 40-50 cm/sec in thyroiditis.
Co-author: Dr. Neeraj Bharti (MD, medicine).
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