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Thyroid Ultrasonography Helps to Identify Patients with Diffuse Lymphocytic Thyroiditis who Are Prone to Develop Hypothyroidism^*

Istituto di Endocrinologia, Metodologia Clinica e Medicina del Lavoro, Università di Pisa 56018 Tirrenia-Pisa, Italy

Address all correspondence and requests for reprints to: Claudio Marcocci, M.D., Istituto di Endocrinologia, Metodologia Clinica e Medicina del Lavoro, Università di Pisa, Viale del Tirreno 64,56018 Tirrenia-Pisa, Italy.

The clinical usefulness of thyroid ultrasonography in the evaluation of patients with autoimmune thyroiditis has been investigated. Thyroid ultrasonography was perfomed in 1184 consecutive patients attending our clinic, and the echo density of the thyroid parenchyma was evaluated with respect to that of normal thyroid tissue. Diffuse thyroid hypoechogenicity was found in 44 of 238 (18.5%) patients with autoimmune thyroiditis; the degree of hypoechogenicity was significantly correlated with the levels of circulating thyroid autoantibodies. Thyroid function was normal in all 194 patients with normal thyroid echogenicity, whereas hypothyroidism was found in 28 of 44 (63.6%) with reduced thyroid echogenicity. Included in this group were 8 patients, euthyroid at the first observation, who developed hypothyroidism over an 18-month follow-up period. None of the 133 patients with autoimmune thyroiditis and normal thyroid echogenicity followed for the same period of time became hypothyroid. Evidence of diffuse lymphocytic thyroiditis was obtained by histology after thyroidectomy (n = 10) or multiple fine needle aspiration cytology (n = 15) in 25 of the 44 patients with thyroid hypoechogenicity; on the other hand, focal thyroiditis was shown at histology in 8 patients who had normal thyroid echogenicity. In conclusion, diffuse low thyroid echogenicity was found in about 20% of patients with autoimmune thyroiditis. This echographic pattern is indicative of diffuse autoimmune involvement of the gland and is associated with or may predict the development of hypothyroidism.

^* This work was supported in part by grants from Ministero della Pubblica Istruzione (60%), the Italian Research Council [Consiglio Nazionale delle Ricerche: target project, Preventive Medicine and Rehabilitation; subproject, Mechanisms of Aging (87.00403.556)], and Ente Nazionale per la Ricerca e lo Sviluppo dell'Energia Nucleare e delle Energie Alternative (E.N.E.A.) Rome, Italy. Presented in part at the 17th Annual Meeting of the European Thyroid Association, Montpellier, Quebec, Canada, September 11-16, 1988.

Received June 18, 1990.

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