Hyperthyroidism - Graves disease

Case contributed by Dennis Odhiambo Agolah
Diagnosis certain


Hyperthyroidism. Patient clinically noted to have symmetrical bilateral exophthalmos.

Patient Data

Age: 25 years
Gender: Female

Moderately enlarged bilateral thyroid lobes with symmetrical bilateral glandular inferno on color and power Doppler mapping that is accompanied with relatively diffuse heteroechogenic parenchymal reflectivity is noted. The right thyroid lobe measures 8.34 cc while the left measures 7.14 cc and the isthmus medially spans 0.63 cm (in the AP dimension).

The fibro-glandular connective tissues show no significant fibrotic changes and the intra-glandular arterial resistive indices of 0.44 for the right and 0.58 for the left lobe noted are within normal limits. No focal solid lesions in either lobe.

Thyroid function test laboratory report

  • free T3 = 2.28 Pg/mL
  • free T4 = 4.00 Pg/mL
  • TSH = 0.05 uIU/mL

Case Discussion

Primary hyperthyroidism clinically occurs when the thyroid stimulation hormone (TSH) levels are low with paradoxically elevated T3/T4 levels. In this presentation (with clinical features of hyperthyroidism), the ultrasound images demonstrate augmented color flow signals within the thyroid gland surface and the isthmus plus heterogenous glandular pattern reflectivity on B-grey mode evaluation. No focal glandular lesions or cervical lymphadenopathy and these features advocate for non-nodular hyperthyroidism. 

Laboratory correlation test findings in this demonstration (low TSH, high T3/T4) corroborate the ultrasound findings of hyperthyroidism however, unequivocally interpret and underpin the diagnosis into a primary onset (primary hyperthyroidism).

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