CC BY
57DOI: 10.24411/2181-0443/2021-10010
АСПЕКТЫ УЛЬТРАЗВУКОВОЙ ДИАГНОСТИКИ ХРОНИЧЕСКОГО ТИРЕОИДИТА
Мардиева Гульшод Маматмурадовна Уринбоева Диляфруз Сунатуллаевна Шукурова Лазиза Борисовна Гиясова Нигора Кобиловна
Самаркандский государственный медицинский институт Самарканд, Узбекистан
Изучены результаты эхографического исследования пациентов с хроническим тиреоидитом. В зависимости от объема щитовидной железы все больные были разделены на 3 группы (гипертрофическая форма, атрофическая форма, с нормальным объемом). Изучение эхоструктуры щитовидной железы при аутоиммунном воспалении позволило выделить различной степени выраженности типы изменения ткани железы и показателей линейных скоростей кровотока. При тиреоидите патогномоничны пониженная эхогенность паренхимы и линейные гиперэхогенные включения. В гиперэхогенных структурах происходит замещение паренхимы на соединительную ткань. При гипертрофической форме хронического тиреоидита отмечается достоверное повышение линейных скоростей кровотока в два раза, при атрофической форме - снижение пиковой систолической и конечной диастолической скоростей кровотока, у больных с нормальным объемом железы, находящихся в состоянии гипо- и эутиреоза, достоверных изменений тиреоидного кровотока не происходит.
Ключевые слова: тиреоидит, ультразвуковое исследование, эхогенность, васкуляризация.
ASPECTS OF ULTRASONIC DIAGNOSTICS OF CHRONIC THYROIDITIS
The results of an echographic study of patients with chronic thyroiditis were studied. Depending on the volume of the thyroid gland, all patients were divided into 3 groups (hypertrophic form, atrophic form, with normal volume). The study of the echostructure of the thyroid gland in autoimmune inflammation made it possible to distinguish types of changes in the gland tissue and indicators of linear blood flow velocities of varying severity. In thyroiditis, pathognomonic decreased echogenicity of the parenchyma and linear hyperechoic inclusions. In hyperechoic structures, the parenchyma is replaced by connective tissue. In the hypertrophic form of chronic thyroiditis, there is a significant increase in linear blood flow velocities by a factor of two, in the atrophic form - a decrease in the peak systolic and end diastolic blood flow velocities, in patients with a normal gland volume in a state of hypo- and euthyroidism, there are no significant changes in thyroid blood flow.
Key words: thyroiditis, ultrasound examination, echogenicity, vascularization.
СУРУНКАЛИ ТИРЕОИДИТДА УЛЬТРАТОВУШ ДИАГНОСТИКАСИНИНГ ЖИХДТЛАРИ
Сурункали тиреоидит билан касалланган беморларнинг ультратовуш текширув натижалари урганилган. ^алкрнсимон без х,ажмига Цараб, барча беморлар 3 гурух,га булинган (гипертрофик шакл, атрофик шакл, нормал хажм билан). ^алЦонсимон безнинг аутоиммун яллиГланишида ультратовушли структурасини урганиш без туЦималарида узгариш турларини ва хар хил турдаги чизиЦли Цон оЦими тезлиги курсаткичларини ажратиб олишга имкон берди. Гиперэхоген тузилмаларда паренхима бириктирувчи туЦима билан алмашуви кузатилади.Сурункали тиреоидитнинг гипертрофик шаклида Цон оЦимининг тезлиги икки баробар купаяди, атрофик шаклида — максимал систолик ва сунгги диастолик Цон оЦими тезлигининг пасайиши, нормал без хажми булган беморларда,гипо- ва эутиреоз холатида, ЦалЦонсимон Цон оЦимида сезиларли узгаришлар булмайди.
Калит сузлар: тиреоидит, ультратовуш текшируви, эхогенлик,Цон томирлари.
At present, the problem of early diagnosis of chronic thyroiditis is relevant due to the steady increase in the incidence [1,2,6,8]. The incidence of autoimmune thyroiditis among the adult population ranges from 6 to 11%, the incidence of clinically apparent forms is 3-45 per 1000 people. In the structure of diffuse nontoxic goiter, autoimmune thyroiditis occupies from 20 to 60%. The number of sick women exceeds the number of men by 4-8 times, the peak incidence falls on the working age of 40-60 years, which makes this problem clinically and socially significant [1,4,5].
Chronic thyroiditis is the most common cause of primary hypothyroidism, which often becomes the leading clinical manifestation of the disease [5,8]. The priority task is the correct selection of techniques that allow you to accurately diagnose with minimal economic and time costs. The leading position in the diagnosis of diffuse thyroid diseases is currently occupied by a complex ultrasound investigation [3,5,6,7]. All of the above substantiates the urgency of the problem and predetermines the goal and objectives of our research.
The purpose of this study is to determine the possibility and place of the ultrasound research method in the diagnosis of chronic thyroiditis.
Material and research methods. Fifty patients with chronic thyroiditis were examined, of which 45 were women and 5 were men. The patients' age ranged from 16 to 62 years. The control group consisted of 10 patients without thyroid pathology. Ultrasound examination was carried out on a SonoScape-S-50 scanner with a linear format transducer at a frequency of 7.5 MHz.
Research results. The male to female ratio was 1: 9. All patients with thyroiditis were divided into 3 groups depending on the volume of the thyroid gland. Group 1 n = 16 (32.0%) consisted of patients with an enlarged thyroid gland - hypertrophic form, group 2 n = 14 (28.0%) - with a decrease in gland volume -atrophic form, group 3 n = 20 (40.0 %) - with normal volume.
Evaluation of the echogenicity of the thyroid parenchyma in the B-mode showed an uneven decrease in the echogenicity of the thyroid tissue
of varying severity in all 50 patients with thyroiditis. Along with this sign, in all patients, diffuse heterogeneity of the parenchyma (from fine to coarse grained) was determined due to the alternation of hypoechoic areas of various sizes, sometimes of a confluent nature, evenly (or unevenly) distributed in the thyroid tissue with zones of medium and increased echogenicity. The presence of hyperechoic inclusions was detected in 20 (40.0%) patients. In 30 (60.0%) patients, there was a deformation of the contours, mainly tuberous deformation of the posterior surface of the thyroid gland. The diagnosis of all patients was confirmed by a comprehensive examination, which included anamnesis, examination, clinical, laboratory data and ultrasound examination of the thyroid gland.
Analysis of the echostructure of the thyroid gland in autoimmune inflammation made it possible to identify the following types of tissue changes:
• slightly altered tissue - against the background of normal parenchyma, hypoechoic inclusions (2-4 mm) with clear contours without "halo" are determined;
• altered tissue - against the background of the parenchyma of reduced echogenicity, hypoechoic inclusions (4-6 mm) with clear contours without "halo" are determined;
• sharply altered tissue - against the background of a general decrease in echogenicity, almost anechoic foci and hyperechoic structures of various sizes and shapes are determined.
As you can see, the main ultrasound signs of thyroiditis are reduced echogenicity of the parenchyma and linear hyperechoic inclusions. The low echogenicity is based on high cellularity due to lymphoid infiltration - in sharply hypoechoic foci, inflammation is most pronounced. In hyperechoic structures, the parenchyma is replaced by connective tissue. Ultrasound results should be assessed in conjunction with the general condition and hormonal profile of the patient.
In patients of group 1 with hypertrophic thyroiditis, we noted an increase in the general vascularization of the thyroid gland on a scale with a mean value of 4.40 ± 0.43 points. A moderate increase in this indicator up to 3-4
points was determined in 6 (12.0%) patients of group 3 with a normal thyroid gland volume. In the 3rd group of patients with thyroiditis, the general vascularization was 2.70 ± 0.62 points and did not differ significantly from the control group. In patients of group 2 with atrophic form of thyroiditis, we did not notice any increase in vascularization. In general, in this group, a significant decrease in vascularization was recorded to 1.55 ± 0.69 points in comparison with the control group.
Thus, in patients with a hypertrophic form of thyroiditis, a significant increase in the general vascularization of the thyroid gland was determined, and in patients with an atrophic form, on the contrary, a significant decrease in the general vascularization of the thyroid parenchyma compared with the studied groups. Patients with thyroiditis with a normal volume of the thyroid gland and patients of the control group did not differ significantly among themselves in this indicator, but their significant difference from patients of groups 1 and 2 was revealed.
In the study of arterial blood flow in the thyroid gland in patients with thyroiditis and patients in the control group, we determined the absence of significant differences (p> 0.05) in linear velocities and peripheral resistance indices (Vps, Ved, RI) in the paired arteries of different sides, as well as between the upper and lower thyroid arteries.
In patients of group 1 with hypertrophic form of thyroiditis in the upper and lower thyroid arteries, a significant increase in peak systolic Vps and end diastolic Ved blood flow velocities was observed almost twice as compared to the control. In patients with atrophic thyroiditis, there was a significant decrease in the peak systolic velocity Vps in the upper and lower thyroid arteries in comparison with the study groups, as well as a significant decrease in the diastolic Ved velocity compared with group 1 (p <0.05).
In the group of thyroiditis patients with a normal thyroid gland volume, compared with the control group, there was a slight increase in the peak systolic velocity Vps in the upper and lower thyroid arteries, but it turned out to be insignificant. The RI resistance index has undergone minor fluctuations. An increase in RI was noted only in the group of patients with atrophic thyroiditis, it was significant compared to the control group, in other cases the differences were insignificant. The absence of significant differences in RI in the studied groups, in our opinion, indicates insignificant changes in peripheral vascular resistance in the arterial bed in thyroiditis.
Findings. 1. Ultrasound examination of the thyroid gland is recommended for screening patients in order to identify thyroid pathology.
2. Chronic thyroiditis is found in women 9 times more often than in men. The peak incidence was noted at the age of 41-60 years (60.0%).
3. Typical ultrasound signs of chronic thyroiditis were various degrees of decrease in echogenicity, diffuse heterogeneity of the structure, the presence of hyperechoic inclusions, deformation of the contours. An increase in the volume of the gland and a thickening of the isthmus were noted in 32.0% (hypertrophic form), a decrease in the volume of the gland - in 28.0% (atrophic form), and the normal volume of the gland was 40.0%.
4. With the hypertrophic form of chronic autoimmune thyroiditis in patients with hypothyroidism, according to the data of ultrasound angiography in the thyroid arteries, there is a significant increase in linear blood flow velocities twice. With the atrophic form of autoimmune thyroiditis and hypothyroidism, there is a significant decrease in peak systolic and end diastolic blood flow velocities by 1.4 - 1.5 times. In patients with autoimmune thyroiditis with normal gland volume, who are in a state of hypo- and euthyroidism, there are no significant changes in thyroid blood flow.
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