[超声检查在亚急性甲状腺炎评估中的作用]

Vulpoi C, Zbranca E, Preda C, Ungureanu M C

Facultatea de Medicină Clinica de Endocrinologie, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi.

Rev Med Chir Soc Med Nat Iasi. 2001 Oct-Dec;105(4):749-55.

Ultrasonography is a useful tool in diagnosing and monitoring thyroid pathology. The aim of this study was to evaluate the value of thyroid ultrasonography in the follow-up of subacute thyroiditis (SAT). The study group included 48 subjects with clinical and biological diagnosis of subacute thyroiditis. All patients were evaluated by ultrasonography and followed-up for a mean period of 12 months. The evaluation protocol included biological data (TSH, T4, erythrocyte sedimentation rate--ESR) and ultrasonography, performed at 1, 2, 3, 6, and 12 months. Initially, all patients had an enlarged thyroid volume (median = 30.5 ml, range 23-90) and a low echogenicity, with an inhomogeneous aspect in 54.1% cases. After a mean period of 3 months thyroid volume had a significant reduction (median volume = 20.2 ml, range 7-36, p < 0.0001). Echogenicity was also significantly improved, with a decrement, on a semi-quantitative scale of 4 degrees (1 = normal, 4 = intense hypoechogenicity), from 3.25 to 2.48 (p < 0.0001). Almost half of the patients (45.8%) presented persistent (although slighter) hypoechoic/inhomogeneous pattern. Ultrasonographic abnormalities were not correlated with the intensity of the inflammatory syndrome and/or the thyroid status. Recurrence appeared in 10 (20.8%) patients. All patients presented a new thyroid enlargement (from a median = 16.1 ml to 31.5 ml, p = 0.056) and an extension of hypoechoic regions. The risk of recurrence could not be correlated with thyroid function, inflammatory syndrome or ultrasonographic aspect. There were not significant differences between the subgroups of patients with and without recurrence concerning the initial thyroid volume (p = 0.889), echogenicity (p = 0.735), TSH (p = 0.321) or ESR (p = 0.1332). Thyroid ultrasonography is useful not only for the initial diagnosis but also for the follow-up of patients with subacute thyroiditis. Remission and recurrence can be appreciated and monitored by the ultrasonographic pattern of the thyroid.

超声检查是诊断和监测甲状腺病变的一种有用工具。本研究的目的是评估甲状腺超声检查在亚急性甲状腺炎（SAT）随访中的价值。研究组包括48例临床和生物学诊断为亚急性甲状腺炎的受试者。所有患者均接受超声检查，并进行了平均12个月的随访。评估方案包括在第1、2、3、6和12个月进行生物学数据（促甲状腺激素、甲状腺素、红细胞沉降率——ESR）和超声检查。最初，所有患者甲状腺体积均增大（中位数 = 30.5 ml，范围23 - 90），回声减低，54.1%的病例表现为不均匀。平均3个月后，甲状腺体积显著减小（中位数体积 = 20.2 ml，范围7 - 36，p < 0.0001）。回声也显著改善，半定量分级从4级（1 = 正常，4 = 强烈低回声）下降4级，从3.25降至2.48（p < 0.0001）。几乎一半的患者（45.8%）呈现持续（尽管较轻）的低回声/不均匀模式。超声异常与炎症综合征的强度和/或甲状腺状态无关。10例（20.8%）患者出现复发。所有复发患者均出现新的甲状腺肿大（从中位数 = 16.1 ml增至31.5 ml，p = 0.056）以及低回声区域扩大。复发风险与甲状腺功能、炎症综合征或超声表现无关。有复发和无复发患者亚组在初始甲状腺体积（p = 0.889）、回声（p = 0.735）、促甲状腺激素（p = 0.321）或红细胞沉降率（p = 0.1332）方面无显著差异。甲状腺超声检查不仅对亚急性甲状腺炎患者的初始诊断有用，而且对其随访也有用。甲状腺的超声模式可用于观察和监测缓解及复发情况。