Sonografie der Schilddrüse - Teil 2: Schilddrüsenentzündungen, Schilddrüsenfunktionsstörungen und Interventionen

Key words

thyroid - sonography - color Doppler sonography - fine-needle aspiration - alcohol injection therapy (PEIT)

Core statements

• Sonography of the thyroid is a method of high diagnostic certainty provided sufficient experience in the examination and good technical equipment.

• Subacute thyroiditis de Quervain may be diagnosed conclusively by B-image sonography (hypoechoic lesions) in more than 90 % of cases if clinical symptoms (pain in the neck, laboratory signs of inflammation) are typical.

• Following iatrogeneous hypothyroidism, chronic lymphocytic thyroiditis is the most common cause of adult hypothyroidism.

• Clinical findings, laboratory values (thyroid hormones, and facultatively, thyroid antibodies) and color Doppler sonography findings (including PSV) are indicative in the differential diagnosis of disturbances of thyroid function.

• Scintigraphy is employed for the diagnosis of autonomous nodules > 1 - 1.5 cm.

• Fine-needle puncture cytology is the most precise and cost-effective procedure for confirming a diagnosis in the case of thyroid nodules suspicious of malignancy.

• If the indication for the procedure is sound, ethanol instillation therapy (PEIT) of autonomous thyroid adenomas is an effective and, in the hands of an experienced examiner, also low-risk method which may be performed on an ambulatory basis.

Literatur/References

• 1 Schott M, Scherbaum A. Autoimmune Schilddrüsenerkrankungen.  Deutsches Ärzteblatt 103.. 2006;  45 B2628-B2634
• 2 Singer P A. Thyroiditis acute, subacute, and chronic.  Med Clin North Am. 1991;  75 61-77
• 3 Birchall I W, Chow C C, Metrewelli C. Ultrasound appearances of de Quervain’s thyreoiditis.  Clin Radiol. 1990;  41 57-62
• 4 Kujat C, Dyck R, Brederhoff J. et al . Diagnose und Therapie der subakuten Thyreoiditis de Quervain.  Dtsch Med Wschr. 1991;  116 1439-1443
• 5 Kunz A, Blank W, Braun B. De Quervains Subacute Thyreoiditis - Colour Doppler Sonography Findings.  Ultraschall in Med. 2005;  26 1-5
• 6 Tokuda Y, Kasagi K, Jida Y. et al . Sonography of subacute thyroiditis. Changes in the findings during the course of the disease.  J Clin Ultrasound. 1990;  18 21-25
• 7 Vitti P, Rago T, Mazzeo S. et al . Thyroid blood flow evaluation by Color-flow Doppler ultrasonography distinguishes Graves’ disease from Hashimoto’s thyreoiditis.  J Endocrinol Invest. 1995;  18 857-61
• 8 Rall P W, Mayekawa D S, Lee K P. et al . Color-flow Doppler sonography in Graves’ disease: „thyroid inferno”.  Am J Radiol. 1998;  150 781-784
• 9 Baldini M, Castagnone D, Rivolta D. et al . Thyroid vascularization by color Doppler ultrasonography in Graves’ disease. Changes related to different phases and to the long-term outcome of the disease.  Thyroid. 1997;  7 823-828
• 10 Becker D, Lohner W, Martus P. et al . Farbdopplersonographische Detektion von fokalen Schilddrüsenautonomien.  Ultraschall in Med. 1999;  20 41-46
• 11 Clark K J, Cronan J J, Scola F H. Color doppler sonography: anatomic and physiologic assessment of the thyroid.  J Clin Ultrasound. 1995;  23 215-233
• 12 Saleh A, Cohen B, Feldkamp J. et al . Differential diagnosis of hyperthyroidism: Doppler sonographic quantification of thyroid blood flow distinguishes between Graves’ disease and diffuse toxic goiter.  2002;  110 32-36
• 13 Boi F, Piga M, Serra A. et al . The usefulness of conventional echo color Doppler sonography in the differential diagnosis of toxic multinodular goitres.  European Journal of Endocrinology. 2000;  143 339-346
• 14 Schulz S L, Seeberger U, Hengstmann J H. Color Doppler sonography in hypothyroidism.  European Journal of Ultrasound. 2003;  16 183-189
• 15 Braun B, Blank W. Farbdopplersonographisch gesteuerte perkutane Alkoholinstillation zur Therapie der funktionellen Schilddrüsenautonomie.  Dtsch med Wschr. 1994;  119 1607-1612
• 16 Blank W, Braun B. Ethanol instillation of adenoma of the thyroid gland - a five year experience.  Min Invas Ther & Allied Technol. 1998;  7 / 6 581-588
• 17 Lippi F, Ferrari C, Manetti L. et al . Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection: results of an Italian multicenter studie.  J Clin Endocrinol Metab. 1996;  81 3261-3264
• 18 Janowitz P, Ackmann S. Langzeitergebnisse der ultraschallgesteuerten Alkoholinstillation bei Patienten mit fokaler Schilddrüsenautonomie und Hyperthyreose.  Med Klin. 2001;  96 341-346
• 19 Schumm-Draeger P M. Ultrasound-Guided Percutaneous Ethanol Injection in the Treatment of Autonomous Thyroid Nodules: A Review.  Exp Clin Endocrinol Diabetes. 1998;  106 59-62
• 20 Mauz P S, Stiegler M, Hollereied M. et al . Complications of Ultrasound Guided Percutaneous Ethanol Injection Therapie of the Thyroid and Parathyroid Glands.  Ultraschall in Med. 2005;  26 142-145