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. Purpose: To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT. Material and 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. Conclusion: 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.
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Several studies have shown that increased vascularity on CFDS may be seen in patients with type 1, but not type 2 AIT.
“Several studies have shown that increased vascularity on CFDS may be seen in patients with type 1, but not type 2 AIT (599-601).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [600]
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“Two studies showed a clear separation into type 1 and type 2 AIT, allowing successful application of targeted therapy (599,600).”
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- Authors
- Loy, M., Perra, E., Melis, A., Cianchetti, M. E., Piga, M., Serra, A., Pinna, G., & Mariotti, S.
- Affiliations
- University of Cagliari (IT)
- Corresponding author
- Loy, M.
- Venue
- Acta Radiologica
- Publisher
- SAGE Publications
- Published
- 2007-07
- Volume
- 48
- Issue
- 6
- Pages
- 628-634
- ISSN
- 0284-1851 (ISSN-L)
- 1600-0455
- OpenAlex
- W2111974263
- Cited by
- 55
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 4 · 2021: 7 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 5 · 2016: 1 · 2015: 2 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Radiologica (publishedVersion)
- PubMed (publishedVersion)
- UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- amiodarone-induced thyrotoxicosis, color flow Doppler sonography, thyroid blood flow, thyroid nodules, toxic nodular goiter, Graves' disease, differential diagnosis, methimazole, prednisone, potassium perchlorate, thyroid scintigraphy, radioiodine uptake
- MeSH terms
- Aged, Amiodarone, Anti-Arrhythmia Agents, Diagnosis, Differential, Female, Goiter, Nodular, Graves Disease, Humans, Male, Middle Aged, Radionuclide Imaging, Retrospective Studies, Thyroid Function Tests, Thyroid Gland, Thyrotoxicosis, Thyrotropin, Thyroxine, Triiodothyronine, Ultrasonography, Doppler, Color
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