Sonoelastography in de Quervain Thyroiditis

Sonoelastography is a novel technique, providing an objective estimation of tissue elasticity by measuring the degree of distortion under the application of an external force (1). Recent studies demonstrated exceptional utility of sonoelastography in preoperative evaluation of thyroid nodules because neoplastic transformation is often associated with decreased elasticity of a lesion (1– 4). However, a sonoelastographic picture of de Quervain thyroiditis (dQT) has not yet been described. Herewithin we report cases of dQT in two women, ages 36 and 42 yr, presenting with malaise, pain in the neck, and temperature up to 38 C. Conventional ultrasonography revealed a picture typical for dQT in the first patient, but only minimal changes in the second patient, whereas sonoelastography in both demonstrated markedly decreased elasticity of the affected area (Figs. 1 and 2). Patients were euthyroid (TSH was 0.29 and 0.57 IU/ml, respectively) and had an increased erythrocyte sedimentation rate (48 and 61 mm/h, respectively). The cytological diagnosis of the specimen obtained by fine-needle biopsy was consistent with dQT. Patients were treated with ibuprofen and prednisone, which resulted in total remission. To conclude, obtained results suggest that inflammatory infiltration of thyroid parenchyma in dQT causes decreased thyroid tissue elasticity. Sonoelastography might be useful in diagnosing dQT, selecting regions for biopsy in patients with minimal changes on conventional ultrasonography, as well as in differential diagnosis with Hashimoto’s thyroiditis. Moreover, the coexistence of dQT may affect interpretation of elasticity of concomitant thyroid nodules. Studies on larger groups are required to further assess the usefulness of elastographic evaluation in dQT.