University of Health Sciences Turkey, Kayseri City Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
University of Health Sciences Turkey, Kayseri City Hospital, Clinic of Radiology, Division of Pediatric Radiology, Kayseri, Turkey
J Clin Res Pediatr Endocrinol. 2023 Feb 27;15(1):7-15. doi: 10.4274/jcrpe.galenos.2022.2022-4-5. Epub 2022 Aug 19.
Hashimoto’s thyroiditis (HT) is the most common form of thyroiditis in childhood. In addition to thyroid ultrasonography, shear-wave elastography (SWE) can evaluate thyroid parenchyma tissue stiffness, and more detailed findings can be obtained with this method. We aimed to evaluate the relationship between SWE values and clinical, biochemical and hormonal parameters of patients with HT and in healthy individuals.
We compared 46 newly diagnosed HT cases with 46 healthy controls. We examined the effect of all metabolic parameters and thyroid-related markers on SWE values.
The mean SWE values in those patients with euthyroid HT were 12.5±5.1 kilopascal (kPa), whereas it was 8.2±2.82 kPa in healthy controls (p<0.001). Although the clinical [age, gender and body mass index (BMI)] and laboratory parameters (such as thyroid function tests, homeostasis model assessment of insulin resistance, insulin-like growth factor-1 values, which we think may affect SWE scores) of those children with HT and the healthy controls were statistically similar (p>0.05), except for their thyroid autoantibodies and thyroglobulin, SWE values and thyroid volume were significantly higher in those individuals with HT (p<0.001). Multiple linear regression analysis was performed to evaluate the direction and degree of the effect of the variables on thyroid elasticity scores. It was observed that age (p=0.002), BMI standard deviation score (SDS) (p=0.04) and anti-thyroid peroxidase (p=0.008) levels were effective on the thyroid elasticity score in the regression model. We detected a SWE cut-off value of 9.68 kPa with 68% sensitivity and 72% specificity, a 70% positive predictive value, and a 69% negative predictive value in thyroid elastography when differentiating between cases with HT and healthy controls.
Our results show that no metabolic factor other than BMI SDS has any effect on SWE scores, especially in healthy children. There was a positive correlation between BMI SDS and SWE in healthy children (r=0.353; p=0.02), but not in those patients with HT (r=0.196; p=0.19). Likewise, age is another factor affecting SWE only in healthy children. We do not recommend routine evaluation of any laboratory parameters other than thyroid functions before thyroid elastography.
桥本甲状腺炎（HT）是儿童期最常见的甲状腺炎形式。除了甲状腺超声检查外，剪切波弹性成像（SWE）还可以评估甲状腺实质组织的硬度，并且该方法可以获得更详细的结果。我们旨在评估 SWE 值与 HT 患者和健康个体的临床、生化和激素参数之间的关系。
我们比较了 46 例新诊断的 HT 病例和 46 例健康对照。我们检查了所有代谢参数和与甲状腺相关的标志物对 SWE 值的影响。
那些甲状腺功能正常的 HT 患者的平均 SWE 值为 12.5±5.1 千帕斯卡（kPa），而健康对照组为 8.2±2.82 kPa（p<0.001）。尽管 HT 患儿和健康对照组的临床[年龄、性别和体重指数（BMI）]和实验室参数（如甲状腺功能检查、胰岛素抵抗稳态模型评估、胰岛素样生长因子-1 值，我们认为这些参数可能会影响 SWE 评分）在统计学上相似（p>0.05），但除了他们的甲状腺自身抗体和甲状腺球蛋白外，HT 患者的 SWE 值和甲状腺体积明显更高（p<0.001）。进行了多元线性回归分析，以评估变量对甲状腺弹性评分的方向和程度的影响。观察到年龄（p=0.002）、BMI 标准差评分（SDS）（p=0.04）和抗甲状腺过氧化物酶（p=0.008）水平在回归模型中对甲状腺弹性评分有影响。我们在甲状腺弹性成像中检测到一个 SWE 截断值为 9.68 kPa，具有 68%的敏感性和 72%的特异性、70%的阳性预测值和 69%的阴性预测值，用于区分 HT 病例和健康对照组。
我们的结果表明，除了 BMI SDS 之外，没有任何代谢因素对 SWE 评分有影响，特别是在健康儿童中。在健康儿童中，BMI SDS 与 SWE 之间呈正相关（r=0.353；p=0.02），但在 HT 患者中则没有（r=0.196；p=0.19）。同样，年龄是影响健康儿童 SWE 的另一个因素。我们不建议在进行甲状腺弹性成像之前常规评估除甲状腺功能以外的任何实验室参数。
