Ultrasonographic perithyroidal lymph node features predict thyroid autoantibody status: a clinical correlation study

Ultrasonographic diagnosis of thyroid diseases has traditionally relied on changes in thyroid echogenicity, which may appear relatively late in the disease course. This study aims to explore an early diagnosis for thyroid diseases before clinical symptoms occur by investigating the surrounding lymph nodes.

This study used a combined case-control and prospective design. Initially, a retrospective review was performed on patients who underwent thyroid ultrasound examination and autoantibody testing at our hospital between February 2024 and July 2025. Patients were divided into four groups based on serological results. Ultrasonographic parameters were recorded for each group. Intergroup data comparison was performed using chi-square test and correlation analysis was conducted. Ultimately, the diagnostic efficacy of lymph node manifestations in each group was analyzed among 100 randomly selected patients with abnormal thyroid echogenicity, and a receiver operating characteristic (ROC) curve was plotted.

The prospective analysis revealed that the area under the ROC curve (AUC) for diagnosing Hashimoto's antibody positivity using ultrasound detection of prelaryngeal, left paratracheal, and right paratracheal lymph nodes were 0.904, 0.845, and 0.829, respectively. When combining all three lymph node sites, the AUC reached 0.887, indicating high diagnostic accuracy, particularly for prelaryngeal lymph node assessment.

Ultrasonographic imaging of lymph nodes surrounding the thyroid gland is significantly associated with the presence of Hashimoto's thyroiditis-specific autoantibodies. These findings suggest that perithyroidal lymph node features may serve as valuable imaging markers for predicting autoimmune thyroid disorders, particularly Hashimoto's thyroiditis.