Right lobe, transverse scan

Right lobe, longitudinal scan

Right lobe, color Doppler mode

Left lobe, transverse scan

Left lobe, longitudinal scan

Left lobe, color Doppler mode

Summary of the first examination

Clinical data: A 15-year-old girl was referred for a screening because her mother has been treated for primary hypothyroidism.

We performed aTPO which resulted in 2.6 U/mL.

Suggestion: TSH every three years.

Summary of ultrasound and laboratory data

Date of examination	Volume of the thyroid lobes (mL)		Echogenicity index	Therapy before	Results of laboratory investigations			Therapy after
	Right lobe	Left lobe			TSH (mIU/L)	FT4 (pM/L)	TSAb U/L)
First visit	5.4	3.8	< 2%	Nothing	1.87	-	-	Nothing
4 years after the first visit	8.3	8.3	50%	Nothing	< 0.001	37.6	5.2	20 mg methimazole
5 years after the first visit	13.1	8.3	10%	5 mg methimazole	10.2	8.6	0.8	Nothing
6 years after the first visit	13.6	9.2	< 10%	Nothing	1.37	10.9	-	Nothing

 

Comment.

1. Considering the significantly increased risk for developing hypothyroidism and the fact that that a hypothyroidism can have adverse effects before causing any complaints, we recommend screening first-degree relative of a patient who has autoimmune thyroid disease. Screening means performance of TSH every three years and in the event of pregnancy at once.

2. This is the usual course of Graves' disease regarding the change in echo pattern - before, during and after the activity of the autoimmune process. The only exception is the change in the size of the thyroid. In most cases, the thyroid increases during the activity of the disease, then returns to normal. However, in this patient the age counts: at the first examination, the patient was only 15-year-old.

3. There are two situations in Graves 'disease where circulation is increased. At the stage of disease activity and when hypothyroidism is observed with medication. In the former case, the blood flow is almost always increased, in the latter it can be decreased and increased.