Dr. Gaurav Kaushik

Resident, Department of Radiodiagnosis

Padmashree Dr. D.Y. Patil Medical college and Hospital.

ULTRASONOGRAPHY AND COLOR

DOPPLER EVALUATION OF THYROID

DISEASES

INTRODUCTION

The role of high resolution Ultrasonography in

the evaluation of the neck region is becoming

increasingly important due to the availability of

high frequency probes.

Detection of thyroid lesions by sonography

are common and the incidence is much higher

than the incidence of palpable thyroid

nodules.

Thyroid sonography is frequently asked to be

performed in the work up of a palpable thyroid

lesion.

Thyroid lesions are often found unrelated to

palpable neck masses.

Along with being much safer and non-ionising,

ultrasound is also much cheaper alternative to

C.T. and M.R.I. which are used in the evaluation

of thyroid masses, but are not as sensitive as

ultrasound in the detection of intrathyroid

lesions but are used for mediastinal extension

of thyroid masses.

Thyroid ultrasound differentiates solid from

cystic lesions, solitary from multinodular and

diffuse enlargement, and extrathyroid lesions.

Nearly 50% of patients with clinically solitary

thyroid nodule have avoided surgery by thyroid

scanning.

The newly developed high resolution

Ultrasonography and color Doppler flow

mapping can reveal fine details of the thyroid

gland and the hemodynamic features of thyroid

neoplasms.

Thus the combination of conventional

sonography and color Doppler provides benefits

in increasing the screening sensitivity and

improves accuracy in distinguishing different

thyroid abnormalities.

An attempt was made in present study to

evaluate and establish certain sonographic

criteria for distinguishing benign and malignant

lesions by evaluating a large spectrum of thyroid

diseases.

Aim and Objectives

1. To study spectrum and role of Ultrasound &

Color Doppler in differentiating different

thyroid diseases.

2. To co-relate Ultrasound & Color Doppler with

fine needle aspiration cytology (FNAC)

Materials and Methods

Type of Study: A Prospective Observational

study

Study Area and Duration: The Study was

conducted in a tertiary care institute and

Medical College of Mumbai for a period of two

years.

Sampling Technique: Consecutive type of

Non-probability Sampling.

Sample Size: A total of 140 patients with

thyroid & parathyroid diseases were referred

& USG of thyroid gland was performed.

Data Analysis: Data was analysed using SPSS

software Ver. 19.

The characteristics studied were the presence

of the nodule, internal characteristic of

lesions, the internal echogenecity of the

nodule, presence of cystic changes, number

of focal lesions,involvement of

gland, calcifications and type of vascularity on

color & power doppler.

The presence of any significant neck nodes

was also recorded.

Patients who had suspicious lesions or

change in image characteristic over time or

with equivocal findings were recommended

USG guided FNAC for further definitive

diagnosis.

Observations

USG and color Doppler diagnosis was carried

out on 140 patients . Out of these 120 cases

underwent USG guided FNAC for final

diagnosis (Rest 20 patients were either

directly went for surgery, managed

conservatively or were complimented by other

diagnostic modalities ).

The age group of the patients ranged from 1-

74 years (mean- 41.2 4.2 years). There

were 46 male and 94 female patients.

Most patients with thyroid disorders presented

with swelling in front of the neck (64%)

followed by features of hypothyroidism in

another 28% of cases.

Main Symptoms Frequency Percent

Asymtomatic 8 5.71%

Constitutional

symptoms 10 7.14%

Difficulty in breathing 4 2.86%

Difficulty in swallowing 8 5.71%

Features of

hyperthyroidism 11 7.86%

Features of

hypothyroidism 28 20.00%

Hoarseness of voice 1 0.71%

Hypercalcemia, raised

PTH 6 4.29%

Swelling in front of neck 64 45.71%

Total 140 100.00%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

10.71%

32.14%

25.00%

8.57%

3.57%

9.29%

3.57% 3.57% 3.57%

Diagnosis (USG/Doppler)

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

10.00%

27.86%

22.14%

7.86%8.57%7.86%

3.57%3.57%1.43%0.71%

2.86%3.57%

Final Diagnosis

USG & DOPPLER DIAGNOSIS

BENIGN 96 68.5%

MALIGNANT 44 31.5%

Total 140 100%

FINAL DIAGNOSIS

BENIGN 109 77.9%

MALIGNANT 31 22.1%

Total 140 100%

STASTISTICAL MEASUREUSG DIAGNOSIS(Malignant

Lesion)

SENSITIVITY 94.50%

SPECIFICITY 85.90%

PPV 67.40%

NPV 98%

Conclusion

The Present study aimed at determining the accuracy of the combination of USG and ColorDoppler in delineating different thyroid diseases.

Amongst them the most important distinction was between relatively benign lesions vssuspicious lesions of malignancy.

The present study shows that combined use of Ultrasound and Color Doppler as a primary investigation in symptomatic patients of thyroid disease allows safe management decisions to be made and can further direct patient for USG guided FNAC for reaching a definitive diagnosis.

We therefore recommend USG and ColorDoppler to be the first Investigation of choice in all suspected thyroid disorders.

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