Endocrine Abstracts (2013) 32 P1062 | DOI: 10.1530/endoabs.32.P1062

Ten ultrasonographic thyroid pattern in Hashimoto's thyroiditis: re-evaluation after 12 years

Dan Peretianu1, Catalina Poiana2, Mara Carsote2, Daniela Cristina Staicu1 & Alexandrina Clodeanu1


1Societatea Civila Medicala ‘Povernei’, Bucharest, Romania; 2C.I. Parhon Institute of Endocrinology, Bucharest, Romania.


Aim: To re-analyze the concept of echographic thyroid patterns (ETP) and clinical diagnostic in thyroidology, proposed 12 years ago.

Materials and methods: i) Between 1996 and 2012, >25 000 thyroid ultrasound, linear probes, 7.5 MHz. ii) New description – 10 ETP: pattern 0, lack of thyroid; 1, marked hypoechogenous pseudonodular; 2, hypoecogen homogenous; 3, micronodular hypoechogenous; 4, macro (>10 mm; ±micro) nodular; 5, inhomogeneous hypo/hyper-echogenous pseudonodular; 6, micronodular anechogenous; 7, hyperechogenous diffuse (normal). In 2013 we added; 8, only slightly hypoechogenous pseudonodular; 9, inhomogenously predominantly hyperechogenic with tubular anechogenic areas. iii) Patients: 1196 HT, 8 ‘sero-negative’ thyroiditis (T S-N), 73 thyroiditis with only hyper ATG-emia (T-ATG), 70 idiopathic mixedema (IM); 72 Graves–Basedow disease (GBD) without HT; 1130 control. iv) Fiability/reliability analysis: on specificity 2012/2003 (95.68) and on sensitivity 2012/2003 (67.82).

Results: i) Number echographies/pattern/disease in Table 1.

ii) Sensitivity, specificity, and predictive positive value for the relationship pattern-diagnostic for HT vs all conditions (control+immune thyroid disease related to HT) in Table 2.

iii) Test χ2 (54 degrees of freedom): >24.36, P<0.001.

iv) Reliability: specificity, 84.7% and sensitivity, 93.97%.

Table 1 Number echographies/pattern/disease.
THT S-NT-ATGIMGBDControl
Pattern 01501749
Pattern 1122315717984
Pattern 219307401377
Pattern 3740333138
Pattern 4129920814529
Pattern 52050813939
Pattern 66000046
Pattern 774051113261
Pattern 8 (new)92050116
Pattern 9 (new)400002
Total19191010187951183
Table 2 Sensitivity, specificity, and predictive positive value for the relationship pattern-diagnostic for HT vs all conditions.
Patterns in HT012345678 (new)9 (new)
Sensitivity0.7863.7310.063.866.7210.680.313.864.790.21
Specificity98.5788.6181.1989.2661.0594.0796.8680.2298.5099.86
VPP41.6787.9938.5233.8218.4370.2111.5420.3380.7066.67
VPN81.5729.7988.4679.6719.3033.33
Accuracy43.1374.5142.8041.2230.2546.7942.1336.9345.3843.37

Conclusions: i) From sensitivity, specificity, and predictive positive value analysis, the classification proposed from 2003 in time (see Endocrine Abstracts 2007–2012) with only seven patterns ETP is exact and correct with ten ones, too: reliability: 84.7 and 93.97%. ii) VPP ~90 asks the diagnostic to be corroborated with antibody levels. Description ‘hypoechogenous-pseudonodular’ does not mean implicitly HT (could be T-ATG, too). iii) VPN >80% for pattern 4, means that, when there is a nodule over 10 mm, then HT is improbable. iv) When there are pattern 6 or 7, normality is almost sure. v) Patterns 1 and 8 suggest HT. vi) Patterns 5 and 9 suggest thyroiditis/Graves–Basedow with thyroid hyperfunction respectively euthyroidism.

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