title: Grey-scale analysis allows a quantitative evaluation of thyroid echogenicity in the patients with Hashimoto's thyroiditis.
abstract: OBJECTIVE
  In the present study we have performed a grey-scale quantitative analysis of thyroid echogenicity in the patients affected by Hashimoto's thyroiditis (HT), obtaining a numerical estimate of the degree of hypoechogenicity associated with the appearance of thyroid dysfunction.
  
  
  METHODS
  The study group included 89 patients with serum positivity for thyroglobulin (TgAb) and/or peroxidase (TPOAb) antibodies. Ultrasound (US) evaluation of thyroid gland and biochemical assay of serum thyrotropin (TSH), free-thyroxine (FT4) and free-triiodiothyronyne (FT3) were performed in all patients, and in 40 healthy subjects enrolled as control group. Thyroid echogenicity was compared with that of the surrounding neck muscles, using the grey-scale histogram analysis. The echogenicity was expressed in grey-scales (GWE).
  
  
  RESULTS
  In HT patients, the mean of thyroid echogenicity was lower when compared to the normal thyroid (61.9 +/- 8.3 GWE vs. 71.9 +/- 3.1 GWE; P = 0.01). In all HT patients the lowest limit of thyroid echo distribution was in the echogenicity range of the surrounding muscle, the overlapping ranging between 3.4% and 95.0% (mean +/- SD 48.4 +/- 20.9%). The extension of like-muscle hypoechogenicity into the thyroid gland was significantly correlated with serum TSH values (r = 0.37; P < 0.001), serum FT4 values (r = -0.60; P < 0.001), and serum TPOAb values (r = 0.31; P = 0.004). Nobody was hypothyroid when the hypoechogenicity was less than 38.0%, whereas hypothyroidism occurred in all cases with hypoechogenicity of more than 68.9%. The receiving operating characteristic curve demonstrated that 48.3% was the best cut-off for identifying hypothyroid patients with sensitivity, specificity and diagnostic accuracy of 88.9%, 86.3% and 87.6%, respectively.
  
  
  CONCLUSIONS
  In conclusion, the grey-scale quantitative analysis has provided a measure of thyroid hypoechogenicity associated with the appearance of hypothyroidism during the course of HT. The results of the present study would encourage the application of the computerized grey-scale analysis as complementary tool to US evaluation in the patients affected by HT.
authors.affiliation: Department of Clinical and Experimental Medicine F. Magrassi & A. Lanzara, Second University of Naples, Italy.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Mazziotti
authors.forename: Francesca
authors.initials: F
authors.lastname: Sorvillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Iorio
authors.forename: Antonella
authors.initials: A
authors.lastname: Carbone
authors.forename: Antonio
authors.initials: A
authors.lastname: Romeo
authors.forename: Marco
authors.initials: M
authors.lastname: Piscopo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Capuano
authors.forename: Ermanno
authors.initials: E
authors.lastname: Capuano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amato
authors.forename: Carlo
authors.initials: C
authors.lastname: Carella
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009333:Neck; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D013967:Thyroiditis, Autoimmune / Q000000981:diagnostic imaging*; D014463:Ultrasonography