Int J Thyroidol.  2019 May;12(1):35-43. 10.11106/ijt.2019.12.1.35.

Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression

• Yoo WS
• Choi HS

• KMID: 2449064
• DOI: http://doi.org/10.11106/ijt.2019.12.1.35

Abstract

BACKGROUND AND OBJECTIVES
Thyroid scan is a good tool for diagnosis of hyperfunctioning thyroid nodules (HNs), however it has been limited in use in a primary clinical practice, because of its inconvenience and low accessibility. This study aimed to analyze ultrasonographic (US) characteristics of HNs and to predict HNs by US.
MATERIALS AND METHODS
We included 114 patients who exhibited results of "˜hot' nodule in the thyroid scan from 2008 to 2017. Analysis for US characteristics included 73 patients without unclear US images and other inevitable reasons. We compared US characteristics of HNs with cold nodules that showed "cold" in the thyroid scan. Additionally, we compared US characteristics of HNs between suppressed thyroid-stimulating hormone (TSH) (<0.25 uIU/mL) or normal TSH, and analysis receiver operating characteristics (ROC) curve for prediction of suppressed TSH among HNs.
RESULTS
The HNs showed more partially cystic nodule, isoechoic echogenicity, hypervascularity and presence of halo in the US finding than the cold nodule. In subgroup analysis of nodules with TSH suppression among HNs, the TSH suppression nodules was lager in max size and volume than the normal TSH nodules. In ROC analyses for prediction of the TSH suppression among HNs, area under receiver operating characteristics curves was 0.736 in max size, 0.761 in volume.
CONCLUSION
HNs showed more frequently partially cystic contents, isoechoic echogenicity, hypervascularity, and peripheral halo sign in US finding. Thyroid nodule size and volume were associated with suppressed TSH level of HNs, and optimal cutoff levels for prediction of TSH suppression among HNs were 2.6 cm and 1.13 cm3, respectively.

Keyword

Hyperfunctioning nodule; Ultrasonography; Thyrotropin

MeSH Terms

Diagnosis
Humans
ROC Curve
Thyroid Gland*
Thyroid Nodule*
Thyrotropin*
Ultrasonography
Thyrotropin

Figure

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  Fig. 1 Flowchart of patient enrollment in hyperfunctioning thyroid nodules.

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  Fig. 2 Area under receiver operating curve (ROC) of max size and volume to predict thyroid stimulating hormone suppression in hyperfunctioning thyroid nodules were 0.736 (95% CI=0.664–0.879, p<0.001) and 0.761 (95% CI=0.698–0.906, p<0.001), respectively.

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  Fig. 3 A case of hyperfunctioning thyroid nodule which showed TSH suppressed as size increased. In 2003, TSH of the patient with 1.63 cm isoechoic nodule on thyroid ultrasound (A) was 1.72 uIU/ml in the normal range. In 2012, the size was increased to 2.67 cm mixed isoechoic nodule on ultrasound (B), and the thyroid scan showed hyperfunctioning thyroid nodule (C) and TSH decreased to 0.01 uIU/ml.

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