Correlations between

clinical features,
laboratory tests and
sonography in
autoimmune thyroiditis

Maximilian Cosma Gliga1, Camelia Gliga1,2, Mihnea

Bogdan Borz1, Matei Boan1
1University of Medicine and Pharmacy of Trgu Mure, Romania;
2University Clinic of Endocrinology of Trgu Mure, Romania
 Introduction

Hashimoto Thyroiditis (HT) is the most

common thyroid autoimmune disease and a
major cause of hypothyroidism in adults (1).
 Symptoms depend on the associated
thyroid dysfunction (most frequent-
hypothyroidism)

High levels of anti thyroid-peroxidase

antibodies (TPOAb) - 90-95% of
cases, elevated levels of anti-
thyroglobulin antibodies (TgAb) -
70% of cases

Sonographic aspects in HT: (8,10,11)

- generalized hypoechogenicity
- marked heterogeneity
- enlarged thyroid- diffuse goiter
- nodular or pseudonodular hypoechoic
lesions
- atrophic thyroid
 Patients and Methods
We realised a prospective study during a period of 6 months on
54 patients diagnosed with Hashimoto Thyroiditis (based on
ultrasound aspect and raised TPOAb levels) in an outpatient clinic
in Tg.Mures.

All patients were investigated by performing anamnesis, physical

exam, thyroid ultrasound and specific laboratory exams: thyroid
hormones (thyroid-stimulating hormone-TSH, free thyroxine fT4
and free triiodothyronine fT3) and TPOAb blood levels.

Based on thyroid function, patients were divided in three

groups: hyperthyroidism, euthyroidism and hypothyroidism.
Based on the sonographic aspect of the thyroid
we created 4 different groups:

Group 1

small volume, atrophic thyroid without nodules

 Group 2

normal volume, without nodules

 Group 3

large volume, without nodules

 Group 4

nodular aspect (at least one

nodule present) regardless of
the volume
 We studied the correlations between the
sonographic aspect, TPOAb levels and
thyroid function on each group and
performed statistical tests (unpaired T-
test and Mann-Whitney test) to compare
the means of the TPOAb values for
distinct groups.
 RESULTS
Age distribution

Age range: 23-78 years

Average age: 55 years
 Associated diseases and personal
medical history
Thyroid function TPOAb values(IU/ml)
normal laboratory values: 0-34 IU/ml

Range: 39-1500 IU/ml

Mean value: 463 IU/ml
 DISCUSSIONS

Prevalence of HT higher in women

Most frequent associated pathology is osteoporosis and

osteopenia (35% of the patients). The average age for
these patients was 55. Most of the patients with associated
bone diseases presented thyroid dysfunctions (74%)

The majority of patients had altered thyroid function

(76%), most of them having low thyroid function
(hypothyroidism- 65%)
 Patients with thyroid dysfunctions showed a higher
antibody activity than those with euthyroidism.

The difference between the TPOAb means from the group

with hypothyroidism and the one with normal function
proved to be statistically significant (p=0,0056)

The TPOAb mean value from the group with

hyperthyrodism was higher than the one with normal
function, but the difference was not statistically significant
(p=0,40)
 Most patients showed a sonographic image
without nodular lesions (group 1, 2 and 3-
65%)

The mean of the TPOAb value from the patients

with modified volume (1+3) was significantly
higher than the one from the group with
normal volume (2) (p=0,0083)

The patients with modified volume also had the

highest percentages of thyroid dysfunctions.
(100% in group 1 and 90% in group 3)
 Correlations between increased antibody activity and
altered thyroid function were also observed in other
studies in literature. (2,3)

There were studies which found positive correlations

between high TPOAb blood level, thyroid disfunctions
and thyroid hypoechogenicity at ultrasound. (4,5,6,7)

Other studies showed no association between thyroid

status, antibody positivity or sonographic
hypoechogenicity. (7)
 In conclusion we observed that higher
levels of TPOAb could be associated with a
more agressive form of the disease and with
more severe functional and morphological
disorders of the thyroid gland in HT.

The thyroid ultrasound investigation in HT

could also determine the phase and severity
of the disease based on certain parameters,
such as size and hypoechogenicity.
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