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Quantitative assessment of thyroid gland elasticity with shear-wave elastography in pediatric patients with
Sedat Giray Kandemirli1, Zuhal Bayramoglu2, Emine Caliskan2
1Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey. gskandemirli@yahoo.com.
Insights
Shear-wave elastography revealed increased thyroid tissue elasticity in children with Hashimoto's thyroiditis, correlating with disease severity. This technique can assess fibrosis in pediatric Hashimoto's thyroiditis.
Area of Science:
- Pediatric Endocrinology
- Radiology
- Immunology
Background:
- Hashimoto's thyroiditis is the most common autoimmune thyroid disease in children.
- Assessing thyroid gland size and tissue elasticity is crucial for evaluating thyroid pathologies.
- Shear-wave elastography (SWE) is an emerging tool for evaluating tissue elasticity in inflammatory conditions.
Purpose of the Study:
- To evaluate thyroid parenchyma elasticity using SWE in pediatric patients diagnosed with Hashimoto's thyroiditis.
- To compare elasticity measurements in these patients with a healthy control group.
- To correlate SWE findings with gray-scale ultrasound classifications of thyroiditis severity.
Main Methods:
- The study included 59 pediatric patients with Hashimoto's thyroiditis and 26 healthy controls.
- Thyroid glands were assessed using shear-wave elastography.
- Hashimoto's thyroiditis patients were categorized into three grades based on gray-scale ultrasound: focal (grade 1), diffuse (grade 2), and fibrotic (grade 3).
Main Results:
- Patients with Hashimoto's thyroiditis exhibited significantly higher elasticity values (14.9 kPa) compared to controls (10.6 kPa) (p < 0.001).
- Elasticity values increased with disease severity: grade 3 (19.7 kPa) > grade 2 (15.5 kPa) > grade 1 (12.8 kPa) (p < 0.05).
- Higher elasticity correlated with more advanced stages of thyroiditis.
Conclusions:
- Shear-wave elastography can effectively assess thyroid parenchyma elasticity in pediatric Hashimoto's thyroiditis.
- SWE findings correlate with the degree of fibrosis and inflammation severity.
- This technique shows promise for evaluating fibrosis in pediatric Hashimoto's thyroiditis, complementing traditional ultrasound.
Objective:
Hashimoto's thyroiditis is the most common autoimmune thyroid disorder in the pediatric age range. Measurement of thyroid gland size is an essential component in evaluation and follow-up of thyroid pathologies. Along with size, tissue elasticity is becoming a more commonly used parameter in evaluation of parenchyma in inflammatory diseases. The aim of the current study was to assess thyroid parenchyma elasticity by shear-wave elastography in pediatric patients with Hashimoto's thyroiditis; and compare the elasticity values to a normal control group.
Materials And Methods:
In this study; thyroid glands of 59 patients with a diagnosis of Hashimoto's thyroiditis based on ultrasonographic and biochemical features, and 26 healthy volunteers without autoimmune thyroid disease and thyroid function disorders, were evaluated with shear-wave elastography. Patients with Hashimoto thyroiditis were further subdivided into three categories based on gray-scale ultrasonography findings as focal thyroiditis (grade 1), diffuse thyroiditis (grade 2), and fibrotic thyroid gland (grade 3).
Results:
Patients with Hashimoto's thyroiditis (n = 59) had significantly higher elasticity values (14. 9 kPa; IQR 12.9-17.8 kPa) than control subjects (10.6 kPa; IQR 9.0-11.3 kPa) (p < 0.001). Of the 59 patients with Hashimoto's thyroiditis, 23 patients had focal thyroiditis involving less than 50% of the gland categorized as grade 1, 24 patients had diffuse involvement of the thyroid gland categorized as grade 2, and 12 patients had marked hyperechoic septations and pseudonodular appearance categorized as grade 3 on gray-scale ultrasound. Based on elastography, grade 3 patients had significantly higher elasticity values (19.7 kPa; IQR 17.8-21.5 kPa) than patients with grade 2 (15.5 kPa; IQR 14.5-17.8 kPa) and grade 1 thyroiditis (12.8 kPa; IQR 11.9-13.1 kPa) (p < 0.05). Patients with grade 2 thyroiditis had significantly higher elasticity values than those with grade 1 thyroiditis (p < 0.05).
Conclusion:
Gray-scale ultrasound findings of heterogeneous echotexture and hypoechoic echogenicity reflect a longer duration of inflammation and may not be found in the initial stages of thyroiditis. Our results indicate that shear-wave elastography could be used to evaluate the degree of fibrosis in Hashimoto's thyroiditis.
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