Improving Diagnostic Coincidence Rate of Graves’ Disease by Ultrasound Examination with Clinical Symptoms

Abstract

Objective: Combining ultrasound parameters with patient’s clinical symptoms to explore the feasibility of improving the diagnostic coincidence rate of hyperthyroidism.Methods: A total of 179 untreated patients with diffuse echogenic changes of the thyroid on ultrasound and abnormal laboratory examinations were enrolled this study. There were 119 cases of hyperthyroidism, 29 cases of subclinical hyperthyroidism, 26 cases of subclinical hypothyroidism, and 5 cases of Hashimoto’s thyroiditis with clinically confirmed diagnosis. The thyroid volume, blood supply grade, peak velocity of the superior thyroid artery (STA) by ultrasound, heart rate (HR), and clinical symptoms was used to determine the optimal indicators for the diagnosis of hyperthyroidism, and to compare these indicators (study group) with the previous ultrasound criteria reported in the literature (control group).Results: According to logistic regression analysis, from all the factors studied, hyperthyroidism symptoms had the most significant correlation with the diagnosis of hyperthyroidism (P = 0.001), followed by STA peak velocity (P = 0.005), HR (P = 0.009), echogenicity(P = 0.015)and blood flow Grade III (P = 0.041) in order of importance, the other factors include thyroid volume, blood flow Grade I and II were not correlated with the diagnosis of hyperthyroidism (P > 0.05). The diagnostic coincidence rate of hyperthyroidism by increased STA peak velocity was 85.7% (102/119), while the hyperthyroidism symptoms significantly increased the diagnostic coincidence rate to 95.8% (114/119). Comparing the study group to the control group, the area under the receiver operating curve (ROC) was 0.993 vs 0.899 (Z = 3.868, P = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 89.92% vs. 68.91%, 96.67% vs. 96.67%, 92.18% vs. 78.21%, 98.17% vs. 97.62%, and 82.80% vs. 61.05%, respectively.Conclusions: The optimal indicators for the diagnosis of hyperthyroidism is the presence of hyperthyroidism symptoms in untreated patients with diffuse echogenic changes of the thyroid, followed by increased STA peak velocity. This suggests that ultrasound doctors should carefully considerate clinical information and instead of just limited to ultrasound itself. By combining ultrasound parameters with the clinical manifestations of patients, the diagnostic coincidence rate can be truly improved.

Keywords

• |hyperthyroidism|clinical symptoms|blood flow velocity|superior thyroid artery|ultrasound