Int J Thyroidol.  2016 Nov;9(2):137-144. 10.11106/ijt.2016.9.2.137.

Thyroid Volume Measured by (99m)Tc-Pertechnetate Scintigraphy and Its Relationship with Clinical Parameters in Korean Patients with Autoimmune Thyroiditis

• Lee SA
• Lee SM
• Yoo SY
• Kim YH
• Koh G

• KMID: 2362349
• DOI: http://doi.org/10.11106/ijt.2016.9.2.137

Abstract

BACKGROUND AND OBJECTIVES
Autoimmune thyroiditis (AIT) is a form of thyroiditis associated with autoimmune antibodies. Few studies have measured thyroid volume in Asians. This study was undertaken to determine the distribution of thyroid volume and to explore possible correlations between thyroid volume and other factors in a Korean cohort.
MATERIALS AND METHODS
Two hundred eleven patients who underwent (99m)Tc-pertechnetate thyroid scintigraphy between 2009 and 2011 were recruited and their thyroid volume was measured. AIT was defined as having thyroperoxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) positivity and TRAb negativity, regardless of thyroid function.
RESULTS
The mean thyroid volume was 32.1 mL in AIT patients. The distribution of thyroid volume was normal after log transformation. Thyroid volume was larger in patients with both autoantibodies than in patients with only one antibody (p<0.001). The first quartile of patients grouped according to thyroid volume were older (52.1 years, p=0.037) than the patients in other quartile groups. Thyroid volume correlated independently with TPOAb titer, and TgAb titer adjusted for other factors in a multivariate analysis.
CONCLUSION
Thyroid volume in Korean AIT patients had an unimodal distribution and correlated with autoantibody titer.

Keyword

Autoimmune thyroiditis; Antithyroid peroxidase antibody; Antithyroglobulin antibody

MeSH Terms

Antibodies
Asian Continental Ancestry Group
Autoantibodies
Cohort Studies
Humans
Multivariate Analysis
Radionuclide Imaging*
Thyroglobulin
Thyroid Gland*
Thyroiditis
Thyroiditis, Autoimmune*
Antibodies
Autoantibodies
Thyroglobulin

Figure

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  Fig. 1. Distribution of thyroid volume in AIT patients (A), histogram (B) Q-Q plots.

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  Fig. 2. Association between thyroid volume and clinical characteristics (A) thyroid volume related with number of autoantibody (B) correlation between thyroid volume and titer of TPOAb (C) correlation between thyroid volume and titer of TgAb (D) correlation between thyroid volume and serum TSH levels. TgAb: antithyroglobulin antibody, TPOAb: antithyroperoxidase antibody, TV: thyroid volume.

Reference

References

1. Davies TF. Ord-Hashimoto's disease: renaming a common disorder–again. Thyroid. 2003; 13(4):317.

2. Hayashi Y, Tamai H, Fukata S, Hirota Y, Katayama S, Kuma K, et al. A long term clinical, immunological, and histological follow-up study of patients with goitrous chronic lymphocytic thyroiditis. J Clin Endocrinol Metab. 1985; 61(6):1172–8.

3. Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Jorgensen T, et al. Thyroid volume in hypothyroidism due to autoimmune disease follows a unimodal distribution: evidence against primary thyroid atrophy and autoimmune thyroiditis being distinct diseases. J Clin Endocrinol Metab. 2009; 94(3):833–9.

4. Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R, Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. J Clin Endocrinol Metab. 1991; 72(1):209–13.

5. Leisner B. Ultrasound evaluation of thyroid diseases. Horm Res. 1987; 26(1–4):33–41.

6. Gutekunst R, Hafermann W, Mansky T, Scriba PC. Ultrasonography related to clinical and laboratory findings in lymphocytic thyroiditis. Acta Endocrinol (Copenh). 1989; 121(1):129–35.

7. Hegedus L, Hansen JM, Feldt-Rasmussen U, Hansen BM, Hoier-Madsen M. Influence of thyroxine treatment on thyroid size and antithyroid peroxidase antibodies in Hashimoto's thyroiditis. Clin Endocrinol (Oxf). 1991; 35(3):235–8.

8. Rieu M, Portos C, Lissak B, Laplanche S, Sambor B, Berrod JL, et al. Relationship of antibodies to thyrotropin receptors and to thyroid ultrasonographic volume in euthyroid and hypothyroid patients with autoimmune thyroiditis. J Clin Endocrinol Metab. 1996; 81(2):641–5.

9. Peterson S, Sanga A, Eklof H, Bunga B, Taube A, Gebre-Medhin M, et al. Classification of thyroid size by palpation and ultrasonography in field surveys. Lancet. 2000; 355(9198):106–10.

10. Fuse Y, Saito N, Tsuchiya T, Shishiba Y, Irie M. Smaller thyroid gland volume with high urinary iodine excretion in Japanese schoolchildren: normative reference values in an iodine-sufficient area and comparison with the WHO/ICCIDD reference. Thyroid. 2007; 17(2):145–55.

11. Lee KR, Cho JH, Kim YJ, Kim HM, Park RW, Suh JH, et al. Ultrasonographic evaluation of Hashimoto's thyroiditis: Comparison of size and echo change with thyroid function. J Korean Soc Med Ultrasound. 1999; 18(4):329–34.

12. Day TA, Chu A, Hoang KG. Multinodular goiter. Otolaryngol Clin North Am. 2003; 36(1):35–54.

13. Freitas JE. Therapeutic options in the management of toxic and nontoxic nodular goiter. Semin Nucl Med. 2000; 30(2):88–97.

14. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl). Dtsch Med Wochenschr. 1981; 106(41):1338–40.

15. Park S, Lee JK, Kim JI, Lee YJ, Lim YK, Kim CS, et al. In vivo organ mass of Korean adults obtained from whole-body magnetic resonance data. Radiat Prot Dosimetry. 2006; 118(3):275–9.

16. Hintze G, Windeler J, Baumert J, Stein H, Kobberling J. Thyroid volume and goitre prevalence in the elderly as determined by ultrasound and their relationships to laboratory indices. Acta Endocrinol (Copenh). 1991; 124(1):12–8.

17. Maravall FJ, Gomez-Arnaiz N, Guma A, Abos R, Soler J, Gomez JM. Reference values of thyroid volume in a healthy, non-iodine-deficient Spanish population. Horm Metab Res. 2004; 36(9):645–9.

18. Loy M, Cianchetti ME, Cardia F, Melis A, Boi F, Mariotti S. Correlation of computerized gray-scale sonographic findings with thyroid function and thyroid autoimmune activity in patients with Hashimoto's thyroiditis. J Clin Ultrasound. 2004; 32(3):136–40.

19. Wesche MF, Tiel-van Buul MM, Smits NJ, Wiersinga WM. Ultrasonographic versus scintigraphic measurement of thyroid volume in patients referred for 131I therapy. Nucl Med Commun. 1998; 19(4):341–6.

20. Brown MC, Spencer R. Thyroid gland volume estimated by use of ultrasound in addition to scintigraphy. Acta Radiol Oncol Radiat Phys Biol. 1978; 17(4):337–41.

21. Phelps E, Wu P, Bretz J, Baker JR Jr. Thyroid cell apoptosis. A new understanding of thyroid autoimmunity. Endocrinol Metab Clin North Am. 2000; 29(2):375–88. viii.

22. Bulow Pedersen I, Laurberg P, Knudsen N, Jorgensen T, Perrild H, Ovesen L, et al. A population study of the association between thyroid autoantibodies in serum and abnormalities in thyroid function and structure. Clin Endocrinol (Oxf). 2005; 62(6):713–20.

23. Radetti G, Gottardi E, Bona G, Corrias A, Salardi S, Loche S, et al. The natural history of euthyroid Hashimoto's thyroiditis in children. J Pediatr. 2006; 149(6):827–32.

24. Radetti G, Maselli M, Buzi F, Corrias A, Mussa A, Cambiaso P, et al. The natural history of the normal/mild elevated TSH serum levels in children and adolescents with Hashimoto's thyroiditis and isolated hyperthyrotropinaemia: a 3-year followup. Clin Endocrinol (Oxf). 2012; 76(3):394–8.

25. Fenzi GF, Giani C, Ceccarelli P, Bartalena L, Macchia E, Aghini-Lombardi F, et al. Role of autoimmune and familial factors in goiter prevalence. Studies performed in a moderately endemic area. J Endocrinol Invest. 1986; 9(2):161–4.

26. Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995; 43(1):55–68.

27. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab. 1990; 71(3):661–9.

28. Pisarek M, Baczyk M, Gryczynska M, Pietz L, Ziemnicka K, Sowinski J. Autoimmunization and multinodular large toxic goiter therapy using repeated doses of 131I. Pol Arch Med Wewn. 2006; 115(6):545–50.

29. Kim KJ, Woo JT, Kim SW, Yang IM, Kim JW, Kim YS, et al. A clinical study on 79 cases of lymphocytic thyroiditis by fine needle aspiration. J Korean Soc Endocrinol. 1991; 6(1):38–44.