title: Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis.
abstract: BACKGROUND
  Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice.
  
  
  OBJECTIVE
  To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT.
  
  
  METHODS
  The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone.
  
  
  RESULTS
  Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive.
  
  
  CONCLUSIONS
  CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.
authors.affiliation: Ultrasonography Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy. mloy@pacs.unica.it
authors.forename: M
authors.initials: M
authors.lastname: Loy
authors.forename: E
authors.initials: E
authors.lastname: Perra
authors.forename: A
authors.initials: A
authors.lastname: Melis
authors.forename: M E
authors.initials: ME
authors.lastname: Cianchetti
authors.forename: M
authors.initials: M
authors.lastname: Piga
authors.forename: A
authors.initials: A
authors.lastname: Serra
authors.forename: G
authors.initials: G
authors.lastname: Pinna
authors.forename: S
authors.initials: S
authors.lastname: Mariotti
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006044:Goiter, Nodular / Q000150:complications / Q000175:diagnosis; D006111:Graves Disease / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013960:Thyroid Function Tests / Q000379:methods; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D013971:Thyrotoxicosis / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D000889:Anti-Arrhythmia Agents; D014284:Triiodothyronine; D013972:Thyrotropin; D000638:Amiodarone; D013974:Thyroxine