title: Role of ultrasonography in the differential diagnosis of thyrotoxicosis: a noninvasive, cost-effective, and widely available but underutilized diagnostic tool.
abstract: OBJECTIVE
  To explore the use of ultrasonography as a diagnostic alternative to the traditional "gold standard" imaging study of nuclear scintigraphy in the evaluation of thyrotoxicosis.
  
  
  METHODS
  We review the relevant literature and share our own experience to highlight the promising role of ultrasonography in thyrotoxicosis. In addition, we present a diagnostic algorithm suggesting liberal use of ultrasonography in the evaluation of thyrotoxicosis.
  
  
  RESULTS
  Ultrasonography has proved effective not only in the differentiation of Graves disease from other types and causes of thyrotoxicosis but also in the detection of subtle thyroid nodules. The latter role is emphasized in light of the recent observation of an increased risk of occurrence of papillary thyroid carcinoma in patients with Graves disease.
  
  
  CONCLUSIONS
  Ultrasonography is a cost-effective, noninvasive, portable, and safe imaging modality in the evaluation of thyrotoxicosis, both for physiologic assessment and for detection of nonpalpable thyroid cancers that may elude identification on physical examination and nuclear imaging studies. Although thyroid scintigraphy remains a standard radiologic study, thyroid ultrasonography can be a practical alternative in many cases and the primary imaging modality in some situations such as during pregnancy and lactation and for evaluation and management of amiodarone-induced thyrotoxicosis.
authors.affiliation: Division of Endocrinology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Alzahrani
authors.forename: Graziano
authors.initials: G
authors.lastname: Ceresini
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Aldasouqi
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006111:Graves Disease / Q000000981:diagnostic imaging / Q000191:economics / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D007774:Lactation; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000191:economics; D012720:Severity of Illness Index; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000191:economics / Q000503:physiopathology; D013971:Thyrotoxicosis / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology; D018615:Ultrasonography, Doppler, Color / Q000009:adverse effects* / Q000191:economics; D016216:Ultrasonography, Prenatal / Q000009:adverse effects / Q000191:economics