Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis

Abstract

ShearWave™ Elastography (SWE) is real-time, quantitative and user-independent technique, recently introduced in the diagnostic work-up of thyroid nodules. Hashimoto's thyroiditis (HT), characterized by variable degrees of lymphocytic infiltration and fibrosis, might affect shear wave propagation. The aim of this study was to assess the feasibility of SWE in cytologically benign thyroid nodules within both Hashimoto's and nonautoimmune thyroid glands. The effect of autoimmunity on the gland stiffness was also evaluated. longitudinal study in a single centre. SWE was performed in 75 patients with a benign thyroid nodule at cytology: 33 with Hashimoto's thyroiditis (HT group) and 42 with uni- or multi-nodular goitre, negative for thyroid autoimmunity (non-HT group). The elasticity index (EI) of the extra-nodular tissue was greater, though not statistically significant, in the HT than in the non-HT group (24·0 ± 10·5 kPa vs 20·8 ± 10·4 kPa; P = 0·206). However, the EI of extra-nodular tissue was related to the TPOAb titre in the HT group (P = 0·02) and was significantly higher in patients with HT receiving L-thyroxine than in the euthyroid subjects (P = 0·02). The EI of thyroid nodules was similar in HT and non-HT groups. In both groups, the stiffness of nodules was significantly higher than that of the embedding tissue. Our data indicate that SWE correctly defines the elasticity of thyroid nodules independently from the coexistence of autoimmune thyroiditis, always being able to differentiate nodular tissue from the surrounding parenchyma. In HT, the stiffness of extra-nodular tissue increases in relation to both the thyroid antibody titre and the degree of impairment of thyroid function.