Ultrasound Images and Thyroid Dysfunction Show Links in Thyroid Disease

Female doctor giving a young female patient an ultrasound of the thyroid gland. Cancer prevention
Some studies have suggested there is an association between abnormalities seen on thyroid ultrasound and thyroid disease. Researchers in Seoul, South Korea sought to find a more definitive connection.

The thyroid glands in children and adolescents with autoimmune diffuse thyroid diseases (AITD) were associated with echogenicity and heterogeneity on ultrasound (US) images. The findings were the results of a retrospective, single-center study published in Scientific Reports.

Electronic medical records at Kangnam Sacred Heart Hospital in South Korea collected between 2000 and 2020 were reviewed. A total of 133 children and adolescents with AITD were assessed for thyroid dysfunction and US features. Patients were broken out into 4 groups (1-4) by US echogenicity and heterogeneity: overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism. Euthyroidism was also included in the review. Free thyroxine and thyroid stimulating hormone (TSH) levels were retrospectively evaluated.

Patients were aged mean 15±3.8 years, and 76.7% were girls. Mean TSH was 8.3±22.4 mIU/L, antithyroglobulin antibodies (TGAb) were 410.81±258.58, antithyroid peroxidase antibodies (TPOAb) were 1276.77±822.53, and TSH receptor antibodies (TRAb) were 23.1±26.9.

During US, 6% of patients were classified as Grade 1, 18.9% as Grade 2, 33.8% as Grade 3, and 41.3% as Grade 4. Hyper-euthyroid TSH levels decreased significantly with increased US grading (P =.027) and hypo-euthyroid TSH levels increased significantly with increased US grading (P =.035).

The patients with grades 1, 2, 3, and 4 were classified as having hypothyroidism (0%, 4%, 6.7%, 16.4%); subclinical hypothyroidism (12.5%, 8%, 17.8%, 9.1%); euthyroidism (75%, 60%, 22.2%, 3.6%; P =.047); subclinical hyperthyroidism (12.5%, 16%, 13.3%, 7.3%); and hyperthyroidism (0%, 12%, 40%, 63.6%), respectively.

In general, the more severe the thyroid dysfunction, the higher the US grade (P =.047).

At follow-up, 11 patients showed changes in both their US grades and thyroid function tests (TFT), with 6 patients showing improvement and 5 showing decline. 

The study was limited by its retrospective, single center design and may not be generalizable to other populations.

Study authors concluded that the degree and severity of hypoechogenicity and heterogeneity observed during US correlated with thyroid dysfunction among children and adolescents with AITD, suggesting that US findings can be used to supplement other tests to evaluate thyroid function.


Park JE, Hwang SM, Hwang J-Y, et al. The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases. Sci Rep. 2021;11(1):19709. doi:10.1038/s41598-021-99016-2