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Letters to the editor

Letters to the editor 3. Gupta RK, Pant CS, Marwah RK, Jayaram G, Sharma SK: Hypoechoic thyroid gland on ultrasound: Its clinical significance and differential diagnosis. (in press). Sonography of Hashimoto’s Thyroiditis The interesting article, “Sonography of Hashimoto’s Thyroiditis” by Hayashi et a1.l has shown correlation between degree of echogenicity of thyroid gland and hypothyroidism. The authors have described two groups, based on the echogenicity of the strap muscles: group A, having the thyroid gland less or as echogenic, and group B, being more echogenic than strap muscles. We have seen 95 cases of Hashimoto’s thyroiditis using B static ultrasonography, and compared the echotexture of the gland with the skin and subcutaneous tissues. At optimal gray scale, the thyroid is more or as echogenic as the skin, and subcutaneous tissue and strap muscles are relatively echo free We feel skin and subcutaneous tissue of the neck are better reference points for comparison with the thyroid gland as compared to strap muscles of the neck, which are relatively anechoic a t optimal grayscale settings. We did not find any correlation between the degree of echogenicity and levels of T3, T4, and TSH. On the contrary, certain cases of Hashimoto’s thyroiditis in the toxic phase showed very low echogenicity of the gland. Few cases with hypothyroidism showed small hypoechoic gland with multiple hyperdense areas suggesting fibrosis. We conclude that there is no correlation between the degree of low echogenicity and T3, T4, and TSH levels, and skin and subcutaneous tissue are better reference points for comparing the echogenicity of the thyroid gland. R. K. Gupta, MD, Department of Ultrasound C. S. Pant, MD, Department of Ultrasound R. K. Marwah, MD, Thyroid Research Centre Institute of Nuclear Medicine and Allied Sciences Probyn Road Delhi--110007, India Dear Editor: We appreciate the interest in our article. Certainly, to compare thyroid echogenicity with skin and subcutaneous tissue is another option in evaluating echogenicity, because there is no accurate way to determine the absolute echogenicity of the tissue at present. However, we feel that use of skin and subcutaneous tissue as a reference is not a practical way of evaluating Hashimoto’s thyroiditis, because their echogenicity is too high. We admit that the echogenicity of the surrounding muscles might be, on the other hand, too low as a reference. But the purpose of our article was to pick up markedly hypoechoic thyroid glands and to know what such severe hypoechogenicity means. We do not know what is the real reason for the discrepancy between the two sets of data, but we suspect that Gupta et al. could have included many only slightly hypoechoic thyroids in the hypoechoic groups. Because echogenicity of the skin and subcutaneous tissue is rather high and such a “relative” way of evaluating tissue echogenicity cannot be said t o be strictly accurate, there are many chances that a number of normal thyroids could be included in the hypoechoic groups. As we stated in the article, our method of using muscles is not strictly accurate either, and the echogenicity of muscles might be too low for reference in some cases. However, in order not to miss markedly hypoechoic, truly hypofunctioning thyroid glands, we believe our method is more practical. We agree that, in certain toxic phases of Hashimoto’s thyroiditis, the echogenicity of thyroid decreases, as occurs in cases with acute or subacute thyroiditis. Such cases change thyroid echogenicity with time, and biopsy of the thyroid was not performed in the acute phase and thus were not included in the series of this article. Nobushige Hayashi, MD Assistant Professor of Radiology Fukui Medical School 23 Shimoaizuki, Matsuoka-cho Yoshida-gun, Fukui 910-11 Japan http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Ultrasound Wiley

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References (2)

Publisher
Wiley
Copyright
Copyright © 1988 Wiley Periodicals, Inc., A Wiley Company
ISSN
0091-2751
eISSN
1097-0096
DOI
10.1002/jcu.1870160214
Publisher site
See Article on Publisher Site

Abstract

3. Gupta RK, Pant CS, Marwah RK, Jayaram G, Sharma SK: Hypoechoic thyroid gland on ultrasound: Its clinical significance and differential diagnosis. (in press). Sonography of Hashimoto’s Thyroiditis The interesting article, “Sonography of Hashimoto’s Thyroiditis” by Hayashi et a1.l has shown correlation between degree of echogenicity of thyroid gland and hypothyroidism. The authors have described two groups, based on the echogenicity of the strap muscles: group A, having the thyroid gland less or as echogenic, and group B, being more echogenic than strap muscles. We have seen 95 cases of Hashimoto’s thyroiditis using B static ultrasonography, and compared the echotexture of the gland with the skin and subcutaneous tissues. At optimal gray scale, the thyroid is more or as echogenic as the skin, and subcutaneous tissue and strap muscles are relatively echo free We feel skin and subcutaneous tissue of the neck are better reference points for comparison with the thyroid gland as compared to strap muscles of the neck, which are relatively anechoic a t optimal grayscale settings. We did not find any correlation between the degree of echogenicity and levels of T3, T4, and TSH. On the contrary, certain cases of Hashimoto’s thyroiditis in the toxic phase showed very low echogenicity of the gland. Few cases with hypothyroidism showed small hypoechoic gland with multiple hyperdense areas suggesting fibrosis. We conclude that there is no correlation between the degree of low echogenicity and T3, T4, and TSH levels, and skin and subcutaneous tissue are better reference points for comparing the echogenicity of the thyroid gland. R. K. Gupta, MD, Department of Ultrasound C. S. Pant, MD, Department of Ultrasound R. K. Marwah, MD, Thyroid Research Centre Institute of Nuclear Medicine and Allied Sciences Probyn Road Delhi--110007, India Dear Editor: We appreciate the interest in our article. Certainly, to compare thyroid echogenicity with skin and subcutaneous tissue is another option in evaluating echogenicity, because there is no accurate way to determine the absolute echogenicity of the tissue at present. However, we feel that use of skin and subcutaneous tissue as a reference is not a practical way of evaluating Hashimoto’s thyroiditis, because their echogenicity is too high. We admit that the echogenicity of the surrounding muscles might be, on the other hand, too low as a reference. But the purpose of our article was to pick up markedly hypoechoic thyroid glands and to know what such severe hypoechogenicity means. We do not know what is the real reason for the discrepancy between the two sets of data, but we suspect that Gupta et al. could have included many only slightly hypoechoic thyroids in the hypoechoic groups. Because echogenicity of the skin and subcutaneous tissue is rather high and such a “relative” way of evaluating tissue echogenicity cannot be said t o be strictly accurate, there are many chances that a number of normal thyroids could be included in the hypoechoic groups. As we stated in the article, our method of using muscles is not strictly accurate either, and the echogenicity of muscles might be too low for reference in some cases. However, in order not to miss markedly hypoechoic, truly hypofunctioning thyroid glands, we believe our method is more practical. We agree that, in certain toxic phases of Hashimoto’s thyroiditis, the echogenicity of thyroid decreases, as occurs in cases with acute or subacute thyroiditis. Such cases change thyroid echogenicity with time, and biopsy of the thyroid was not performed in the acute phase and thus were not included in the series of this article. Nobushige Hayashi, MD Assistant Professor of Radiology Fukui Medical School 23 Shimoaizuki, Matsuoka-cho Yoshida-gun, Fukui 910-11 Japan

Journal

Journal of Clinical UltrasoundWiley

Published: Feb 1, 1988

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