Evaluation of thyroid congestion in patients with heart failure using shear wave elastography: An observational study.

Shear wave elastography (SWE) is a noninvasive method for measuring organ stiffness. Liver stiffness measured using SWE reflects hepatic congestion in patients with heart failure (HF). However, little is known about the use of SWE to assess other organ congestions. This study aimed to evaluate the utility of SWE for assessing not only the liver but also thyroid congestion in patients with HF. This prospective study included 21 patients with HF who have normal thyroid lobes (age: 77.0 ±â€…11.0, men: 14). Thyroid and liver stiffness were measured by SWE using the ARIETTA 850 ultrasonography system (Fujifilm Ltd., Tokyo, Japan). SWE of the thyroid was performed on B-mode ultrasonography; a target region was identified within a region of interest. SWE was performed in each lobe of the thyroid gland. Five measurements were taken at the same location and the averages were recorded for comparison. We investigated the relationship between SWE for evaluating thyroid stiffness and the clinical characteristics of patients with HF. SWE of the thyroid was significantly correlated with SWE of the liver (R = 0.768, P < .001), thyroid stimulation hormone (R = 0.570, P = .011), free thyroxine (R = 0.493, P = .032), estimated right atrial pressure (RAP; R = 0.468, P = .033), and composite congestion score (R = 0.441, P = .045). SWE may be useful for evaluating thyroid stiffness and assessing the degree of thyroid congestion. Thyroid congestion may reflect the elevation of RAP and cause thyroid dysfunction through organ congestion.

[Review on ultrasonographic diagnosis of thyroid diseases based on deep learning].

In recent years, the incidence of thyroid diseases has increased significantly and ultrasound examination is the first choice for the diagnosis of thyroid diseases. At the same time, the level of medical image analysis based on deep learning has been rapidly improved. Ultrasonic image analysis has made a series of milestone breakthroughs, and deep learning algorithms have shown strong performance in the field of medical image segmentation and classification. This article first elaborates on the application of deep learning algorithms in thyroid ultrasound image segmentation, feature extraction, and classification differentiation. Secondly, it summarizes the algorithms for deep learning processing multimodal ultrasound images. Finally, it points out the problems in thyroid ultrasound image diagnosis at the current stage and looks forward to future development directions. This study can promote the application of deep learning in clinical ultrasound image diagnosis of thyroid, and provide reference for doctors to diagnose thyroid disease.

Diagnosis of thyroid disease using deep convolutional neural network models applied to thyroid scintigraphy images: a multicenter study.

Objectives: The aim of this study was to improve the diagnostic performance of nuclear medicine physicians using a deep convolutional neural network (DCNN) model and validate the results with two multicenter datasets for thyroid disease by analyzing clinical single-photon emission computed tomography (SPECT) image data. Methods: In this multicenter retrospective study, 3194 SPECT thyroid images were collected for model training (n=2067), internal validation (n=514) and external validation (n=613). First, four pretrained DCNN models (AlexNet, ShuffleNetV2, MobileNetV3 and ResNet-34) for were tested multiple medical image classification of thyroid disease types (i.e., Graves' disease, subacute thyroiditis, thyroid tumor and normal thyroid). The best performing model was then subjected to fivefold cross-validation to further assess its performance, and the diagnostic performance of this model was compared with that of junior and senior nuclear medicine physicians. Finally, class-specific attentional regions were visualized with attention heatmaps using gradient-weighted class activation mapping. Results: Each of the four pretrained neural networks attained an overall accuracy of more than 0.85 for the classification of SPECT thyroid images. The improved ResNet-34 model performed best, with an accuracy of 0.944. For the internal validation set, the ResNet-34 model showed higher accuracy (p < 0.001) when compared to that of the senior nuclear medicine physician, with an improvement of nearly 10%. Our model achieved an overall accuracy of 0.931 for the external dataset, a significantly higher accuracy than that of the senior physician (0.931 vs. 0.868, p < 0.001). Conclusion: The DCNN-based model performed well in terms of diagnosing thyroid scintillation images. The DCNN model showed higher sensitivity and greater specificity in identifying Graves' disease, subacute thyroiditis, and thyroid tumors compared to those of nuclear medicine physicians, illustrating the feasibility of deep learning models to improve the diagnostic efficiency for assisting clinicians.

The Role of Nuclear Medicine in Benign Thyroid Disease.

Since the mid-twentieth century, the radionuclide thyroid scan has been utilized in the management of benign thyroid disorders. In current medical practice, patients with hyperthyroidism are referred for thyroid scintigraphy, while patients with goiters and thyroid nodules are most often evaluated by ultrasound or computed tomography. Since thyroid scintigraphy reflects the functional state of the gland, it provides information that anatomical imaging lacks. Therefore, radionuclide imaging of the thyroid is the imaging modality of choice in the evaluation of the hyperthyroid patient. In addition, patients with so-called subclinical hyperthyroidism often present a diagnostic dilemma to the clinician since the causative factor must be determined for proper patient management. The aim of this manuscript is to illustrate the imaging characteristics of thyroid disorders commonly seen in clinical practice resulting in thyrotoxicosis or pending thyrotoxicosis, so that correlation with clinical presentation and pertinent laboratory data will lead to the correct diagnosis.

Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care.

OBJECTIVES: This study aims to evaluate whether the use of thyroid ultrasound (US) early in the work-up of suspected thyroid disorders triggers cascade effects of medical procedures and to analyse effects on morbidity, healthcare usage and costs. STUDY DESIGN: Retrospective analysis of claims data from ambulatory care (2012-2017). SETTING: Primary care in Bavaria, Germany, 13 million inhabitants. PARTICIPANTS: Patients having received a thyroid stimulating hormone (TSH) test were allocated to (1) observation group: TSH test followed by an early US within 28 days or (2) control group: TSH test, but no early US. Propensity score matching was used adjusting for socio-demographic characteristics, morbidity and symptom diagnosis (N=41 065 per group after matching). PRIMARY AND SECONDARY OUTCOME MEASURES: Using cluster analysis, groups were identified regarding frequency of follow-up TSH tests and/or US and compared. RESULTS: Four subgroups were identified: cluster 1: 22.8% of patients, mean (M)=1.6 TSH tests; cluster 2: 16.6% of patients, M=4.7 TSH tests; cluster 3: 54.4% of patients, M=3.3 TSH tests, 1.8 US; cluster 4: 6.2% of patients, M=10.9 TSH tests, 3.9 US. Overall, reasons that explain the tests could rarely be found. An early US was mostly found in clusters 3 and 4 (83.2% and 76.1%, respectively, were part of the observation group). In cluster 4 there were more women, thyroid-specific morbidity and costs were higher and the early US was more likely to be performed by specialists in nuclear medicine or radiologists. CONCLUSION: Presumably unnecessary tests in the field of suspected thyroid diseases seem to be frequent, contributing to cascades effects. Neither German nor international guidelines provide clear recommendations for or against US screening. Therefore, guidelines on when to apply US and when not are urgently needed.

Significance of FDG-PET standardized uptake values in predicting thyroid disease.

Objective: This study aimed to determine a standardized cut-off value for abnormal 18F-fluorodeoxyglucose (FDG) accumulation in the thyroid gland. Methods: Herein, 7013 FDG-PET/CT scans were included. An automatic thyroid segmentation method using two U-nets (2D- and 3D-U-net) was constructed; mean FDG standardized uptake value (SUV), CT value, and volume of the thyroid gland were obtained from each participant. The values were categorized by thyroid function into three groups based on serum thyroid-stimulating hormone levels. Thyroid function and mean SUV with increments of 1 were analyzed, and risk for thyroid dysfunction was calculated. Thyroid dysfunction detection ability was examined using a machine learning method (LightGBM, Microsoft) with age, sex, height, weight, CT value, volume, and mean SUV as explanatory variables. Results: Mean SUV was significantly higher in females with hypothyroidism. Almost 98.9% of participants in the normal group had mean SUV < 2 and 93.8% participants with mean SUV < 2 had normal thyroid function. The hypothyroidism group had more cases with mean SUV ≥ 2. The relative risk of having abnormal thyroid function was 4.6 with mean SUV ≥ 2. The sensitivity and specificity for detecting thyroid dysfunction using LightGBM (Microsoft) were 14.5 and 99%, respectively. Conclusions: Mean SUV ≥ 2 was strongly associated with abnormal thyroid function in this large cohort, indicating that mean SUV with FDG-PET/CT can be used as a criterion for thyroid evaluation. Preliminarily, this study shows the potential utility of detecting thyroid dysfunction based on imaging findings.

Ultrasound findings of the thyroid gland in children and adolescents.

Ultrasonography (US) is an important diagnostic tool in evaluating thyroid diseases in pediatric patients. This pictorial essay reviews the application of various ultrasound techniques such as B-Mode ultrasound and color Doppler, elastography and contrast enhanced ultrasound (CEUS) in children and adolescents in various thyroid pathologies including congenital thyroid abnormalities, diffuse thyroid diseases (DTD), focal thyroid lesions and thyroid malignancy.

New insights into thyroid dysfunction in patients with inactivating parathyroid hormone/parathyroid hormone-related protein signalling disorder (the hormonal and ultrasound aspects): One-centre preliminary results.

Objective: This study aimed to present the spectrum of thyroid dysfunction, including hormonal and ultrasound aspects, in a cohort of paediatric and adult patients diagnosed with inactivating parathyroid hormone (PTH)/PTH-related protein signalling disorders 2 and 3 (iPPSD). Methods: The medical records of 31 patients from 14 families diagnosed with iPPSD between 1980 and 2021 in a single tertiary unit were retrospectively analysed. Biochemical, hormonal, molecular, and ultrasonographic parameters were assessed. Results: In total, 28 patients from 13 families were diagnosed with iPPSD2 (previously pseudohypoparathyroidism [PHP], PHP1A, and pseudo-PHP) at a mean age of 12.2 years (ranging from infancy to 48 years), and three patients from one family were diagnosed with iPPSD3 (PHP1B). Thyroid dysfunction was diagnosed in 21 of the 28 (75%) patients with iPPSD2. Neonatal screening detected congenital hypothyroidism (CH) in 4 of the 20 (20%) newborns. The spectrum of thyroid dysfunction included: CH, 3/21 (14.2%); CH and autoimmune thyroiditis with nodular goitre, 1/21 (4.8%); subclinical hypothyroidism, 10/21 (47.6%); subclinical hypothyroidism and nodular goitre, 1/21 (4.8%); primary hypothyroidism, 4/21 (19%); and autoimmune thyroiditis (Hashimoto and Graves' disease), 2/21 (9.6%). Thyroid function was normal in 7 of the 28 (25%) patients with iPPSD2 and in all patients with iPPSD3. Ultrasound evaluation of the thyroid gland revealed markedly inhomogeneous echogenicity and structure in all patients with thyroid dysfunction. Goitre was found in three patients. Conclusion: The spectrum of thyroid dysfunction in iPPSD ranges from CH to autoimmune thyroiditis and nodular goitre. Ultrasonography of the thyroid gland may reveal an abnormal thyroid parenchyma.

[Thyroid ultrasound and its role in the investigation of thyroid disease]. / Ultraljud värdefullt komplement i utredning av tyreoideasjukdom.

In Europe thyroid ultrasound has been used at outpatient endocrine clinics since many years, and in southern Sweden only during the last years. Ultrasound has a role in the investigation of Graves' disease, subacute thyroiditis, gestational thyrotoxicosis, postpartum thyroiditis, amiodarone thyrotoxicosis and goiter with or without adenoma, but adenomas are usually investigated by endocrine surgeons in Sweden. If widely used the risk for detection of incidentaloma increases. Indications have to be strictly used to avoid further investigations. If an adenoma is localized, the risk for malignancy and requirement of aspiration is estimated by use of the EU-TIRADS classification based on morphology and size. The aspirate is judged by the Bethesda classification, which determines if further investigation is needed. The use of ultrasound at the outpatient clinic has improved the diagnostic quality and follow-up of thyroid patients.

[Radioiodine testing in clinical routine: Status in Germany 2021]. / Statuserfassung des Radiojodtests im klinischen Alltag in Deutschland 2021.

INTRODUCTION AND AIM: According to the German guideline on Radiation Protection in Medicine, the activity to be applied for radioiodine therapy of benign thyroid diseases is determined for each patient by means of the radioiodine test (RJT). The aim of this study is to record the different parameters of the RJT. MATERIAL AND METHODS: A web-based questionnaire was sent to all nuclear medicine departments in Germany via the DGN office. Parameters regarding tracer and activity, type of probe measurement, number and timing of measurements, use of fixed effective half-lives (eHWZ), calculation model and organ doses were requested. An assessment of continuous measurement of the thyroid iodine uptake over seven days by a wearable probe system was also requested. RESULTS: 38 of 94 facilities responded to the questionnaire. Major differences in RJT implementation were found concerning the parameters number and timing of measurements, probe-patient distance, use of fixed disease-specific eHWZ, and intended organ dose. Despite the DGN Guideline and DIN 6861-1, 74% of the facilities still use the simplified Marinelli formula from the DGN Recommendation of 1998. Only 8% have switched to the two-compartment model. 84% of the institutions expect that a wearable probe system could improve the calculation of the radioiodine activity necessary for treatment, but only 57% expect an improvement in the therapeutic outcome. CONCLUSIONS: The methodology of RJT in Germany is heterogeneous and still based on the "Marinelli method" in most institutions despite new guidelines and recommendations. A continuous measurement of the iodine kinetics using a wearable probe system could result in further improving the radioiodine test in addition to the newer calculation algorithms.

Ultrasonography of the thyroid, parathyroids, and beyond.

BACKGROUND: Ultrasonography has become an essential tool for the evaluation and management of thyroid and parathyroid diseases. Its applications extend beyond neck endocrine conditions to a multitude of pathologies within the head and neck region. OBJECTIVES: Our study aimed to: (1) provide a broad review of neck ultrasonography and key findings in neck endocrine diseases; (2) support skilled performance office-based diagnostic ultrasonography and its varied applications. MATERIALS AND METHODS: A review of the current literature was supplemented with clinical examples of key ultrasonographic findings. RESULTS: Current applications and key findings of ultrasonography in the diagnosis and management of neck endocrine conditions are reviewed. CONCLUSION: Ultrasonography is a fundamental component in the evaluation and management of neck endocrine diseases. The reader is encouraged to use this review to enhance office-based performance and application of ultrasonography.

[Diagnostic efficiency of transcutaneous laryngeal ultrasound in assessing the mobility of vocal cord in patients with thyroid disease]. / Diagnosticheskaya effektivnost' ul'trasonografii gortani u patsientov s zabolevaniyami shchitovidnoi zhelezy.

OBJECTIVE: To assess the diagnostic efficiency of transcutaneous laryngeal ultrasound. MATERIAL AND METHODS: Ultrasound examination of the larynx and laryngoscopy was performed in 103 patients with thyroid disease. 26 (34.21%) patients who underwent surgery on the thyroid gland direct laryngoscopy and ultrasound of the vocal folds were performed twice, before and after the operation. RESULTS: Voice folds were visualized in 76 (73.8%) people. Of the 24 men, these anatomical structures were visualized in 8 (33.3%) and in 68 (86.1%) women out of 79 cases. Violations of the function of the vocal cords during laryngoscopy were detected in 5 people, sonographically in 6 people. The coincidence of the revealed pathology with ultrasound was in 4 patients, in 3 - with sonography the diagnosis was erroneous, in 1 patient it was falsely negative and in 2 cases it was falsely positive. CONCLUSIONS: In connection with the diagnostic capabilities of the method, it is advisable to use it as a screening study in the perioperative period in patients with diseases of the thyroid gland. Laryngoscopy is indicated for patients with non-visualized vocal folds, with identified pathology with ultrasound, and with clinical signs of dysfunction of the vocal cords.

Pediatric Neck Masses: Imaging Guidelines and Recommendations.

Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.

Thyroid parameters variations in healthcare workers and students exposed to low-dose ionizing radiations.

SUMMARY: Background. Ionizing Radiations (IR) are an important occupational risk factor for the potential damage that can cause to workers' health and for their presence in numerous professional settings. Health care workers (HCW) can be exposed to IR from various sources, in particular from x-rays using radiological equipment, and represent the largest group of workers occupationally at risk, despite increased regulation and protection which caused exposure to low dose radiations. The thyroid gland is one of the most sensitive organs to damage and an important target of IR, leading to functional and organic diseases. The aim of this study is to assess the variations in thyroid hormones, in a population of HCW exposed to low-dose IR. Methods. 121 individuals of the Teaching Hospital Policlinico Umberto I in Rome exposed to low-dose of IR (78 HCW, 17 Residents and 26 Radiology Technicians Students) were observed assessing serum levels of different thyroid function parameters as free triiodothyronine, free thyroxine and thyroid stimulating hormone at T1, T2 and DeltaT. Age, gender, history of thyroid diseases, BMI and smoke were analyzed as possible influencing factors using linear and multiple logistic regression analysis. Results. Analyzing TSH, fT3 and fT4 serum levels, in two different measurement (T1 and T2) and considering Delta between them, adjusting for different confounding factors, data showed no variation of TSH levels related to occupational exposure, a decrease of fT3 hormone values in HCW and residents, and an increase of fT4 in HCW. Discussion. The analysis of our results revealed that hospital occupation has an impact on thyroid hormones variations, with an increase of fT4 and a decrease of fT3 and no variations of TSH. These results are in conflict with previous studies evidences, in which both free hormones decreased with a concomitant increase of TSH. Conclusion. Exposure to low dose IR influences levels of free thyroid hormones, with no variation in TSH, which could result in a functional or organic disease. For this reason it is recommended continuous surveillance through a periodic check of all the thyroid hormones for an overall view of each HCW. However, further studies are necessary to confirm hormones trend and assess any related thyroid diseases.

Thyroid disorders and pathospermia in the ART clinic patients.

OBJECTIVE: Over the past decade, a decrease in the semen quality in men of reproductive age, along with an increase in the incidence of thyroid diseases among young patients have been clearly noticed. The study was designed to determine various forms of pathospermia in the ART clinic patients with thyroid disorders. MATERIALS AND METHODS: 168 men of reproductive age in infertile marriage were examined. Men with male infertility factor associated with erectile dysfunction and normospermia (9 patients, 5.3%) were excluded. The study included 159 men and the patients were divided into three groups: the 1st study group consisted of men with non-obstructive azoospermia - 11 men (6.9%); the 2nd study group included men with other forms of pathospermia - 38 men (23.9%) and the control group consisted of men in infertile marriage with normospermia - 110 men (69.2%). All patients had anthropometric measurements, laboratory tests, thyroid and testicular ultrasonography. Spermogram was analyzed in accordance with the WHO classification, 5th revision, 2010. RESULTS: Among all examined men with pathospermia (n = 49 patients), 51.02% had various thyroid disorders, while it was firstly verified in 34.7% men. In 45.5% patients with non-obstructive azoospermia, previously undiagnosed nodular goiter with normal values of thyroid-stimulating hormone and free thyroxine were found, and a significant correlation between nodular goiter and the presence of azoospermia was revealed: r = 0.610, p = .01. CONCLUSION.: Men with various forms of pathospermia and patients of the ART clinic had higher risks of thyroid disorders than in general population that could possibly affect fertility. Patients of the ART clinic with non-obstructive azoospermia are at risk for nodular thyroid disorders, even with normal values of thyroid function tests, and require thyroid ultrasonography.

Preoperatory imaging evaluation in primary hyperparathyroidism and associated thyroid disease.

BACKGROUND: Primary hyperparathyroidism (pHPT) is an endocrinological disorder characterized by excessive secretion of parathormone. Minimally invasive approach has become a widespread surgical method for pHPT treatment due to the improvement of preoperative gland localization imaging techniques and the use of intraoperative PTH dosage (IOPTH). We discuss the results of different imaging technique. MATERIALS AND METHODS: We have conducted a retrospective analysis of 80 patients that underwent surgery for primary hyperparathyroidism in the period between 01/01/2012 and 28/02/2018 and we have focused our data collection on preoperative study, intraoperative findings and follow-up data. We have evaluated the concordance between the findings of the most used imaging techniques, copresence of thyroid disease and IOPTH. RESULTS: SPECT-CT showed the best results in terms of positivity (93.1%), sensitivity (88.9%) and accuracy (82.8%). Neck ultrasound resulted to have the best positive predictive value (94.4%). IOPTH decrease was correlated with patients' healing (p <0.05). Age lower than 70 years, post-operative calcium and PTH serum levels were related to a higher chance of healing (p <0.05). CONCLUSION: US-scintigraphy combination is suitable for preoperative evaluation and SPECT/CT confirms to be the best additional examination; the presence of thyroid disease decrease the sensitivity. IOPTH is an important predictor of healing KEY WORDS: Intraoperative PTH, Hyperparathyroidism, Parathyroidectomy, SPECT/CT, Thyroid disease.

Automatic differentiation of thyroid scintigram by deep convolutional neural network: a dual center study.

BACKGROUND: 99mTc-pertechnetate thyroid scintigraphy is a valid complementary avenue for evaluating thyroid disease in the clinic, the image feature of thyroid scintigram is relatively simple but the interpretation still has a moderate consistency among physicians. Thus, we aimed to develop an artificial intelligence (AI) system to automatically classify the four patterns of thyroid scintigram. METHODS: We collected 3087 thyroid scintigrams from center 1 to construct the training dataset (n = 2468) and internal validating dataset (n = 619), and another 302 cases from center 2 as external validating datasets. Four pre-trained neural networks that included ResNet50, DenseNet169, InceptionV3, and InceptionResNetV2 were implemented to construct AI models. The models were trained separately with transfer learning. We evaluated each model's performance with metrics as following: accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), recall, precision, and F1-score. RESULTS: The overall accuracy of four pre-trained neural networks in classifying four common uptake patterns of thyroid scintigrams all exceeded 90%, and the InceptionV3 stands out from others. It reached the highest performance with an overall accuracy of 92.73% for internal validation and 87.75% for external validation, respectively. As for each category of thyroid scintigrams, the area under the receiver operator characteristic curve (AUC) was 0.986 for 'diffusely increased,' 0.997 for 'diffusely decreased,' 0.998 for 'focal increased,' and 0.945 for 'heterogeneous uptake' in internal validation, respectively. Accordingly, the corresponding performances also obtained an ideal result of 0.939, 1.000, 0.974, and 0.915 in external validation, respectively. CONCLUSIONS: Deep convolutional neural network-based AI model represented considerable performance in the classification of thyroid scintigrams, which may help physicians improve the interpretation of thyroid scintigrams more consistently and efficiently.