COLOR DOPPLER SONOGRAPHY IN GRAVES-DISEASE - VALUE IN ASSESSING ACTIVITY OF DISEASE AND PREDICTING OUTCOME

OBJECTIVE. The aims of the study were to establish the usefulness of c olor Doppler sonography in assessing changes in thyroid blood flow dur ing the course of Graves' disease and to investigate which of several variables (thyroid volume, number of intraparenchymal vessels, and blo od flow in the thyroid artery) were best related to thyroid hyperfunct ion and therefore could be used to evaluate the course of the disease. SUBJECTS AND METHODS. Fifty-six patients with Graves' disease were se lected and divided on the basis of clinical and laboratory data into f our groups: patients untreated at first diagnosis, patients undergoing antithyroid drug treatment, patients in remission after withdrawal of therapy, and patients having a relapse of hyperthyroidism. Ten health y subjects served as controls. RESULTS. Patients with active hyperthyr oidism (at first diagnosis, during treatment, or at relapse) had a sig nificantly enlarged thyroid (p =.005); intrathyroid vascularization, e valuated as number of vessels per square centimeter (p <.0001); and bl ood flow in the thyroid artery (p <.0001) compared with control subjec ts and with patients in remission after withdrawal of therapy. During treatment, sonographic values were slightly lower but not significantl y different from those registered in patients at the onset of hyperthy roidism, indicating that normalization of vascularity does not paralle l the drug-induced decrease of hormonal synthesis, Among 21 patients i n remission, the nine patients who had a relapse shortly after the exa mination had a higher number of vessels per square centimeter (2.18 +/ - 0.34 versus 1.03 +/- 0.16, p = .03) and higher flow in the thyroid a rtery (80.3 +/- 19.1 versus 10.6 +/- 2.3 ml/min, p =.01) than did the other 12 patients who remained in stable remission, despite normal hor monal levels in both groups. CONCLUSION. Our results suggest that colo r Doppler sonography can be used to assess activity of Graves' disease and to predict the outcome of the disease after withdrawal of medical therapy.