title: Relationship between the sonographic appearance of the thyroid and the clinical course and autoimmune activity of Graves' disease.
abstract: OBJECTIVE
  The aim of this study was to investigate the relationship between thyroid echogenicity and clinical course/immunologic parameters in Graves' disease.
  
  
  METHODS
  Two hundred and six outpatients with Graves' disease (31 men, 175 women; 46 +/- 23 years old) were studied with thyroid sonography and color Doppler sonography. Forty-five patients were treated for active hyperthyroidism, 161 were euthyroid (85 immediately before withdrawal of antithyroid drug at maintenance doses, 76 in stable remission after withdrawal of antithyroid treatment). Free triiodothyronine, free thyroxine, thyrotropin, and disease-specific autoantibodies (antithyrotropin-releasing hormone antibody) were determined in all patients.
  
  
  RESULTS
  The ultrasound images were classified on the basis of homogeneous, finely unhomogeneous, or micronodular appearance. The proportion of unhomogeneous plus micronodular patterns was greater in hyperthyroid (77.8%) than in euthyroid patients (62.1%). In the latter group, the pattern distribution was significantly different in patients who were antibody positive relative to patients who were antibody negative (p < 0.01). In the stable remission subgroup, the pattern distribution differed according to thyrotropin levels (p < .01). There was a correlation between echopattern and color Doppler sonography as vascularization variables progressively increased in the transition from homogeneous to unhomogeneous and micronodular echopattern (most evident echotexture changes).
  
  
  CONCLUSIONS
  A sonographic-based classification in Graves' disease can distinguish subgroups of patients with different clinical courses and disease activity. This procedure is easy to perform and correlates well with clinical findings.
authors.affiliation: Department of Internal Medicine, University of Milan, Division of Internal Medicine I, IRCCS Ospedale Maggiore, via F. Sforza 35, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Baldini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orsatti
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Bonfanti
authors.forename: Daniela
authors.initials: D
authors.lastname: Castagnone
authors.forename: Luigi
authors.initials: L
authors.lastname: Cantalamessa
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000032:analysis; D005260:Female; D006111:Graves Disease / Q000000981:diagnostic imaging* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011989:Receptors, Thyrotropin / Q000032:analysis; D012008:Recurrence; D013961:Thyroid Gland / Q000098:blood supply / Q000000981:diagnostic imaging*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D018615:Ultrasonography, Doppler, Color
chemical_list: D001323:Autoantibodies; D011989:Receptors, Thyrotropin; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine