Doppler ultrasound in the diagnosis and treatment of toxic forms of goiter

May 12, 2023
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Purpose: to determine the diagnostic value of ultrasound dopplerography in the treatment and preparation for surgical intervention in toxic forms of goiter during a comprehensive examination.

Object and research methods. 230 patients aged 20–75 with toxic forms of goiter were examined or treated. In a separate group, 42 patients were allocated, in which thyrotoxicosis was a manifestation of nodular forms of the disease of the parenchyma of the thyroid gland (TG). In addition to this category of patients, a fine-needle aspiration biopsy of the TG was performed with a cytological conclusion.

Results. Doppler color flow mapping (CFM) in 140 (61%) patients before the course of treatment with thyrostatic drugs demonstrates increased peri- or intratissue blood flow with a resistance index (RI) of 0.32–0.42, with a diffuse distribution of vessels (symptom of the «burning steppe», or «thyrotoxic hell»). After an active course of treatment, the CFM in the parenchyma no longer had a clear, uniform distribution with a high RI value of 0.72, and the blood flow was determined by the CFM only at the periphery. In 32 (14%) patients, a wide range of RI of 0.34–0.74 was considered to be the result of blood circulation through a small network of vessels, the appearance of areas of arteriovenous shunts and various narrowings of the lumen of vessels, cicatricial changes from the outside, and the progression of relapse of the main disease. The study of nodes with the use of CFM against the background of clinical thyrotoxicosis made it possible to distinguish types of vascular patterns: perinodular blood flow of varying intensity in 26 (62%) patients with an RI of 0.45–0.54, uneven in the nodule parenchyma and perinodular zone in 6 (14%) of patients with RI 0.38–0.44 and lack of blood flow in and around the pathological focus in 10 (24%) patients.

Conclusions. Doppler ultrasound of the echo structure and vascularization parameters of parenchyma of TG increases the effectiveness of preoperative diagnosis and the degree of preparation of the patient for surgery. RI is a quantitative informative indicator of blood flow that complements the data on the angioarchitectonics of the tissue of TG in the CFM.

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