Endocrine Abstracts

Aim: Diagnosis of Graves’ is generally based on clinical presentation and physical examination of thyroid gland. The general assumption is that the thyroid gland is usually normal or diffusely enlarged in Graves’ disease. The aim of our retrospective observational analysis was to establish the ultrasonographic morphology of the thyroid gland in patients with Graves’ disease.

Methods: We analysed the case records and biochemical investigations of all patients with thyrotoxicosis presenting to the Endocrinology out-patient of a district general hospital over the last 4 years (2009–2012). The diagnosis of Graves’ disease was confirmed by the presence of TSH receptor antibody (TRAB). Patients who had both positive TRAB antibody (considered to be diagnostic of Graves’ disease with specificity 98% as per literature) and US of the thyroid gland were included for analysis.

Results: 433 patients were diagnosed as thyrotoxic. TRAB was positive in 199 patients. Ultrasound of the thyroid was done in 126 out of 199 TRAB positive patients. 53% (N-67) patients had typical features expected of Graves’ on US namely normal gland, diffuse enlargement, asymmetrical enlargement or features of thyroiditis. However, 47% (N-59) patients had demonstrated nodularity on USG: 95% (N-58) of these patients had multinodular goitre (MNG), of whom 23 patients had dominant nodule in the MNG and the rest had MNG without any dominant nodule. 5% (N-3) patients had solitary nodule.

Conclusion: This retrospective analysis demonstrates the diverse morphology of thyroid gland in patients with Graves’ disease. Coexistent thyroid nodules may warrant further evaluation with Uptake scan or biopsy. Our study highlights the need to consider ultrasound as an essential part of evaluation of Graves’ disease. This is even more pertinent in hospitals where TRAB is not routinely available.