Ushakov Thyroid Clinic, Moscow, Russia.
J Med Life. 2024 Jan;17(1):116-122. doi: 10.25122/jml-2023-0507.
Ultrasound can identify important characteristics in primary hypothyroidism and diffuse hyperthyroidism (Graves' disease). Therefore, sonologists are actively investigating ultrasound criteria to differentiate between these two conditions. Nevertheless, practice shows the absence of such ultrasonic landmarks. For the first time in the literature, three cases of primary hypothyroidism have demonstrated an ultrasound pattern identical to that of Graves' disease. This pattern includes the presence of goiter, marked total hypoechogenicity of the parenchyma, significantly or moderately increased blood flow intensity ('thyroid inferno'), and elevated peak systolic velocity of the superior thyroid arteries. These signs are less common in hypothyroidism compared to hyperthyroidism. Diagnostic data suggest that the pathogeneses of primary hypothyroidism and Graves' disease share the same mechanisms, leading to similar thyroid ultrasound patterns. One of these shared mechanisms is presumably thyroid overstimulation by the autonomic nervous system, which is adequate to the body's hormonal requirements in hypothyroidism but excessive in hyperthyroidism.
超声可以识别原发性甲状腺功能减退症和弥漫性甲状腺功能亢进症（格雷夫斯病）的重要特征。因此，超声科医生正在积极研究超声标准来区分这两种情况。然而，实践表明，并不存在这样的超声标志物。本文首次报道了三例原发性甲状腺功能减退症患者，其超声表现与格雷夫斯病完全相同。这种模式包括甲状腺肿的存在、实质的明显总低回声、显著或中度增加的血流强度（“甲状腺火海”）以及甲状腺上动脉收缩期峰值速度的升高。与甲状腺功能亢进症相比，这些征象在甲状腺功能减退症中较为少见。诊断数据表明，原发性甲状腺功能减退症和格雷夫斯病的发病机制有共同的机制，导致相似的甲状腺超声模式。其中一个共同的机制可能是自主神经系统对甲状腺的过度刺激，这种刺激在甲状腺功能减退症中足以满足身体的激素需求，但在甲状腺功能亢进症中则过度。
