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Thyroid heterogeneity related to antithyroid antibodies in Hashimoto’s disease
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In a recent study, researchers in Japan were successful in correlating thyroid heterogeneity with antithyroid antibodies through the use of ultrasonographic examinations. These findings suggest subsequent thyroid damage due to Hashimoto’s thyroiditis could be predicted through the heterogeneity of the thyroid tissue, according to data.
The researchers compared 44 consecutive patients with euthyroid Hashimoto’s thyroiditis (mean age, 60.5 years) with 30 age-matched controls. The heterogeneity index was calculated as the coefficient of variance of ultrasonographic intensities of either four points per lobe of the thyroid gland along a horizontal line at the depth of the right common carotid artery, researchers wrote. They evaluated serum levels of free thyroxine, free triiodothyronine, thyroid-stimulating hormone, antithyroid peroxidase antibodies (TPOAb), antithyroglobulin antibodies (TgAb), thyroglobulin and thyroid volume.
Data indicate no differences for TSH, free T4 and free T3, thyroglobulin and thyroid volume between the two groups. However, heterogeneity index demonstrated significant differences (3.59% in patients with Hashimoto’s thyroiditis vs. 3.23% for controls; P=.089). Among patients with Hashimoto’s thyroiditis, researchers observed a significant and positive correlation between heterogeneity index and TPOAb (P=.034), according to data. However, this correlation was not observed among normal controls.
“In summary, our results demonstrate the close relation between heterogeneity of the thyroid gland and TPOAb in euthyroid and subclinical hypothyroid patients with Hashimoto’s thyroiditis,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Jennifer Sipos, MD
Hashimoto’s thyroiditis can present with variable ultrasonographic features. The classic findings of hypoechogenicity and heterogeneity may be inconsistently seen in those with early-stage disease. The authors of this study sought to examine the role of a new technology, referred to as the heterogeneity index or HI, in the workup of euthyroid hashimoto’s patients without visible heterogeneity. They found that although there was a nonsignificant difference in the HI between euthryoid hashimoto’s patients and normal controls, there was a trend toward having a higher HI in those with disease. Additionally, there was a positive correlation between the HI and the presence of thyroid peroxidase antibodies. The authors argue that this finding is an indication of early thyroid destruction from the hashimoto’s thyroiditis.
While the findings of these authors are thought-provoking, further study is needed in a larger group of patients, including the evaluation of those with various stages of Hashimoto’s. Moreover, it is important to establish the reproducibility of findings when any new technology is introduced. Finally, it would be interesting to examine whether serial measurements of the HI correlates with the progression of inflammation and onset of hypothyroidism. Such information might be beneficial for predicting the need for levothyroxine replacement therapy before patients become symptomatic from hypothyroidism.
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