COLOR DOPPLER SONOGRAPHY PATTERNS RELATED TO HISTOLOGICAL-FINDINGS INGRAVES-DISEASE

The aim of this work was to correlate color duplex sonography (CDS) pa tterns and thyroid histology in hyperthyroid Graves' disease (GD) pati ents. Sixteen patients with relapsed GD were studied. Before starting a new cycle of medical therapy with methimazole in decreasing doses fo r 3 to 6 months (baseline study), the patients underwent functional, a utoimmune, and CDS studies. The same studies were carried out again ju st before surgery (presurgical study) after medical therapy had produc ed a normalization of thyroid hormone serum levels. The thyroid glands were histologically examined and their patterns were compared with CD S patterns. Thirty-three normal subjects were used as a control group. At baseline, 6 patients (group I) had intraparenchymal homogeneous va scular color spots or diffusely distributed over the parenchyma lobe o r in areas alternating with avascular zones (CDS-A pattern). In 8 pati ents (group II) the thyroid had vascular bands with avascular or poorl y vascularized parenchymal areas (CDS-B pattern). In 2 patients, the 2 patterns were present in the same thyroid (A-B pattern or mixed patte rn). In these 2 patients the histological aspects were more similar to the CDS-B pattern than the CDS-A pattern. The 2 groups of patients di ffered in the velocity of systolic peak (VP) that was significantly hi gher in group I than in group II. in the presurgical study, no changes relative to CDS patterns were observed in patient groups I and II. Th e VP did not show any appreciable modifications in either group of pat ients. The thyrotropin-stimulating antibodies (TRAb) returned to norma l levels in group II, but not in group I. The 2 CDS patterns, observed in the baseline study, were histologically characterized either by a richly vascularized parenchyma with prevalent endothelial hyperplasia (parenchymatous goiter, CDS-A) or by fibrotic septation with prevalent vascular intimal hyperplasia (CDS-B). In conclusion, this CDS study i n GD patients showed 2 distinct vascular patterns. The thyroid glands were histologically characterized by either a richly capillary vascula rized parenchyma (parenchymatous goiter, CDS-A aspect) or by fibrotic septation with prevalent intraseptal arteriolar-like hyperplasia (fibr ous goiter, CDS-B aspect). Such differences may be secondary to a diff erent duration of hyperthyroidism and/or intensity of TRAb thyroid sti mulation.