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VOLUME 9 , ISSUE 2 ( May-August, 2017 ) > List of Articles


Role of Color Doppler Ultrasonography in Differentiation of Graves’ Disease from Thyroiditis: A Prospective Study

Rv Suresh, KS Thalavai Sundarram,, Dhalapathy Sadacharan,, Krishnan Ravikumar,, S Kalpana,

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

DOI: 10.5005/jp-journals-10002-1208

License: CC BY 3.0

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2017; The Author(s).



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

Materials and methods

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.

How to cite this article

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.

  1. Thyroid ultrasound. Indian J Endocr Metab 2013 Mar-Apr;17(2):219-227.
  2. Quantitative measurement of thyroid blood flow for differentiation of painless thyroiditis from Graves’ disease. Clin Endocrinol (Oxf) 2007 Jul;67(1):41-45.
  3. The significance of thyroid blood flow at the inferior thyroid artery as a predictor for early Graves’ disease relapse. Clin Endocrinol (Oxf) 2005 Dec;63(6):657-662.
  4. ; Kotlyarov, PM.; Mogutov, MS.; Alexandrov, YK.; Sencha, AN.; Patrunov, YN.; Belyaev, DV. Complex ultrasound diagnosis of thyroid diseases. In: Ultrasound diagnostics of thyroid diseases. Berlin Heidelberg: Springer; 2010. p. 19-33.
  5. Modern technologies of ultrasound examination in diagnosis of thyroid disease. N Engl J Med 2000 Oct;343(17):1236-1248.
  6. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid 1997 Aug;7(4):541-545.
  7. Review article: Graves’ disease thyroid color-flow Doppler ultrasonography assessment. Health 2014 Jun;6(12):1487-1496.
  8. Mean peak systolic velocity of the superior thyroid artery is correlated with radioactive iodine uptake in untreated thyrotoxicosis. J Int Med Res 2012;40(2):640-647.
  9. Color-flow Doppler sonography in Graves’ disease: “thyroid inferno”. Am J Roentgenol 1988 Apr;150(4):781-784.
  10. Diagnostic approach to thyroid diseases. Progress in ultrasonography of the thyroid and its application (in Japanese). Nihon Naika Gakkai Zasshi 2010 Apr;99(4):726-732.
  11. Role of color Doppler in differentiation of Graves’ disease and thyroiditis in thyrotoxicosis. World J Radiol 2013 Apr;5(4):178-183.
  12. Role of ultrasonography in the differential diagnosis of thyrotoxicosis: a noninvasive, cost-effective, and widely available but underutilized diagnostic tool. Endocr Pract 2012 Jul-Aug;18(4):567-578.
  13. Utility of colour Doppler sonography in patients with Graves’ disease. West Indian Med J 2009 Dec;58(6):566-570.
  14. Peak systolic velocity of superior thyroid artery, for differential diagnosis of thyrotoxicosis. PLoS One 2012 Nov;7(11):e50051.
  15. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis. J Endocrinol Invest 1995 Dec;18(11):857-861.
  16. Reference values for Doppler ultrasound parameters of the thyroid in a healthy iodine-non-deficient population. Br J Radiol 2007 Aug;80(956):625-630.
  17. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011 Jun;21(6):593-646.
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