Thyrotoxicosis due to Graves’ disease (GD) and destructive thyroiditis (DT) needs differentiation, as management strategy differs. Factors that help in diagnosis are biochemical and nuclear imaging. Utility of high-resolution ultrasonography (HRUSG) and color Doppler (CD) in differentiation is not widely practiced. We undertook the prospective study in the Department of Endocrine Surgery at a tertiary care center among South Indian population in 1 year as a cost-effective model

Out of 120 newly diagnosed thyrotoxicosis patients, 54 were GD (group I) and 66 were DT (group II) patients. Totally, 55 euthyroid patients served as controls. Parameters analyzed were demography, free thyroid function test (TFT) anti-thyroid-stimulating hormone receptor antibody (TSHrAB), antithyroid peroxidase antibody (ATPO), anti-thyroglobulin antibody (ATG), and Tc-99m thyroid scintigraphy. Parameters analyzed using HRUSG and CD were peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), resistive index (RI) of bilateral superior thyroid artery (STA) and inferior thyroid artery (ITA).

Both groups were age and sex matched. The TFT, ATPO, and ATG were comparable between both groups (p = 0.609). The TSHrAB (IU/mL) was significantly higher in group I (36.11 ± 0.82) than group II (1.23 ± 0.24) (p < 0.001). Mean thyroid volume (mL) was higher in group I (28.9 ± 14.9) than group II (26.2 ± 8.81) (p = 0.022). Mean PSV-STA (cm/s) was statistically higher in group I (54.09 ± 4.67) than group II (28.92 ± 4.39) (p ≤ 0.001). Mean PSV-ITA (cm/s) was higher in group I (32.11 ± 2.45) than group II (25.23 ± 3.45) (p = 0.006). Other parameters measured in both arteries like mean EDV (cm/s), mean RI, and mean PI were comparable between both groups.

The HRUSG with CD evaluation of PSV STA and ITA is a cost-effective alternative to TSHrAB and thyroid scintigraphy in differentiating GD from DT patients. Additionally, we observed that PSV in STA was higher than in ITA in patients with GD. To conclude, HRUSG and CD are simple, cost-effective, and widely available tools in the differentiation of GD from DT.

Sundarram KST, Sadacharan D, Ravikumar K, Kalpana S, Suresh RV. Role of Color Doppler Ultrasonography in Differentiation of Graves’ Disease from Thyroiditis: A Prospective Study. World J Endoc Surg 2017;9(2):41-45.