Takashima S, Nomura N, Tanaka H, Itoh Y, Miki K, Harada T
Department of Radiology, Osaka Teishin Hospital, Japan.
AJNR Am J Neuroradiol. 1995 May;16(5):1117-23.
To determine the clinical utility of cervical ultrasound in patients suspected of having congenital hypothyroidism.
Thirty-seven patients with suspected congenital hypothyroidism underwent ultrasound and scintigraphic evaluation of the thyroid anatomy, morphology, and function. The ultrasound findings and laboratory data were compared with the standard-of-reference scintigraphic findings and laboratory data for diagnosing specific causes in those patients, and prognosis was correlated with the ultrasound findings.
Ultrasound was not reliable for detecting ectopia (n = 8) or differentiating ectopia from aplasia (n = 1). Ultrasound showed ectopia in six (four in the mouth floor and two in the tongue base) of eight cases (75% sensitivity). Ultrasound did not show one ectopia in the floor of mouth because its echogenicity was similar to that of surrounding tissues. A second ectopia, in the hypopharynx, was missed because of hindrance of the laryngeal air. Radioactive iodine uptake and scintigraphy was required for the patients with enlarged glands in the normal place to differentiate dyshormonogenesis from other categories. Specific causes were diagnosed correctly with ultrasound findings and laboratory data alone in all of the 20 patients who had hemiaplasia or small or normal-size glands in the normal location. Incidences of heterogeneity and hypoechogenicity of the thyroid gland in patients with prolonged clinical course (whose replacement therapy or follow-up extended for more than 1 year) were significantly higher than those in patients with short clinical course.
Ultra-sound can obviate the need for scintigraphy in more than half (54%) of patients with possible congenital hypothyroidism. Ultrasound has a potential to predict prognosis of these patients.
确定颈部超声在疑似先天性甲状腺功能减退症患者中的临床应用价值。
37例疑似先天性甲状腺功能减退症患者接受了甲状腺解剖、形态和功能的超声及闪烁扫描评估。将超声检查结果和实验室数据与用于诊断这些患者特定病因的参考标准闪烁扫描结果和实验室数据进行比较，并将预后与超声检查结果相关联。
超声在检测异位甲状腺（n = 8）或区分异位甲状腺与甲状腺发育不全（n = 1）方面不可靠。超声显示8例中的6例（4例位于口底，2例位于舌根）存在异位甲状腺（敏感性75%）。由于其回声与周围组织相似，超声未显示1例口底异位甲状腺。由于喉内气体的干扰，漏诊了1例下咽异位甲状腺。对于甲状腺位置正常但增大的患者，需要进行放射性碘摄取和闪烁扫描以区分激素合成障碍与其他类型。在所有20例甲状腺半侧发育不全或位置正常但腺体较小或大小正常的患者中，仅根据超声检查结果和实验室数据就能正确诊断出特定病因。临床病程较长（替代治疗或随访超过1年）的患者甲状腺异质性和低回声发生率明显高于临床病程较短的患者。
超声可使超过一半（54%）可能患有先天性甲状腺功能减退症的患者无需进行闪烁扫描。超声有预测这些患者预后的潜力。
