1、The ultrasonic diagnosis of Hashimoto thyroiditisTutor:ZhengMin Speaker:WangLing1 Introduction Clinical manifestations Ultrasound performance Differential diagnosis Summary2 Hashimoto thyroiditis also called chronic Hashimoto thyroiditis also called chronic lymphocytic thyroiditis,Japanese scholars
2、lymphocytic thyroiditis,Japanese scholars Hashimoto Hashimoto reported firstly according to the histologic according to the histologic features features ，that is the most common one of that is the most common one of autoimmune thyroid diseases.HT disease slowautoimmune thyroid diseases.HT disease sl
3、owlyly,clinical manifestationclinical manifestation is not is not very typical;And the very typical;And the course of a long,pathological changes and thyroid course of a long,pathological changes and thyroid function state performance is differfunction state performance is differentent,so the ,so th
4、e ultrasonography findings ultrasonography findings is is plex.3 From 80%to 90%patients mainly manifested as thyroid diffuse enlargement of asymmetry,thyroid texture tough such as rubber sample,with the surrounding tissue without adhesion.The late course is more nodular or atrophy.Early may have hyp
5、erthyroidism performance；Late hypothyroidism,May be due to thyroid atrophy performance for myxedema,impotent and so on.45 thyroid diffuse enlargement of asymmetry,isthmus is obvious.The internal echo reduction,uneven distribution.The visible thin wire-like or coarse network-like strong echo .Two dim
6、ensional ultrasonography6 Local HT is relatively rare,that is a special type,early manifest.Such as effectively and timely treatment,prognosis and outcome is betterUltrasonography is one side or both side lobe of thyroid own single or multiple uneven and hypoechoic zone,boundary clear,form owe rules
7、,like“pattern”,space occupying lesion effect is not obvious.78 Echo Unevenness type:Normal thyroid volume or biger,multiple uneven,Increasing coarse or fine wire sample strong echo.Patch type:Normal thyroid volume or biger,diffused distribution sheet hypoecho.Diffuse type:Thyroid volume increase,Ess
8、ence is diffuse type echo reduce.Nodules type:Thyroid volume increase,diffuse distribution ranging from the size of the high、low or equal echo.9回声不均型回声不均型：甲状腺球蛋甲状腺球蛋白抗体（白抗体（TGA）阳性，）阳性，T3、T4、TSH正常正常10斑片型斑片型11弥漫型弥漫型12结节型结节型13 Ultrasonic found tracheal side swollen lymph nodes,Is autoimmune thyroid dis
9、ease more specific ultrasonic one of the signs,manifest:Thyroid isthmus front,bilateral leaf under round or oval echoic,morphological rules,part of the skin medulla boundary clear.14early period:essence Blood flow signal rich,Even the inferno sign,PSV rise,Prompt hyperthyroidism or normal.With the p
10、rogress of the disease:The rich blood flow significantly lower level,PSV dropped even lower than normal,Prompt typothyroidism.later period:Blood flow signal significantly reduced,velocity obviously reduced,Prompt Thyroid function significantly impaired.15 HT flow signal most significantly increased-
11、fire syndrome,The signs may occur early hyperthyroidism stage,also be found in the late hypothyroidism stage,This note should notice thyroid PSV,and combine thyroid function tests.16Subacute thyroiditisNodular goiterHyperthyroidism17 Thyroid profile is normal or increased，seen in sheet hypoechoic ar
12、ea，more irregular，rear echo slightly enhanced，the isthmus is no obvious thickening。CDFI：blood flow is rich surrounding hypoechoic area，but internal flow signals is fewer or no Signal。Subacute thyroiditis18192021 The former increase mainly about the size of thyroid，the latter increase mainly anteropo
13、sterior diameter，Isthmus thickening，an internal network or a cord-like echogenic。Hyperthyroidism222324 Two dimensional ultrasonography：Thyroid solitary or multiple nodules，Vary in size、Echo diversification，CDFI：Blood flow signal occurring in between nodule，but Nodules in the peripheral and intranodu
14、lar blood flow signal less.Nodular goiter 252627 HT ultrasonography has certain characteristics,in the diagnosis and differential diagnosis of clinical significance.In view of the long course of disease,comorbidity,with complicated clinical manifestations,its sonographic appearances are also different,still needed to be combined with clinical and laboratory examinations considering.HT has complicated with thyroid cancer,on the basis of HT found hypoechoic nodules or calcification,should be considered,so as to avoid misdiagnosis.2829
