The Utility of Shear Wave Elastography in Hashimoto Disease: A Systematic Review and Meta-analysis

This is the authors' abstract. We don't add key points for this paper.

Objective Hashimoto's thyroiditis (HT), also known as chronic autoimmune thyroiditis, is one of the most common thyroid disorders and a leading cause of hypothyroidism. Diagnosis typically relies on clinical features, elevated thyroid autoantibodies (anti-thyroid peroxidase antibodies [TPOAb], anti-thyroglobulin antibodies [TgAb]) and ultrasound findings such as hypoechogenicity. Shear wave elastography (SWE) has emerged as a promising tool to evaluate tissue stiffness associated with lymphocytic infiltration and fibrosis in HT. This systematic review and meta-analysis aimed to synthesize existing evidence and determine if SWE could serve as a valuable diagnostic tool for HT. Methods A comprehensive literature search was conducted in PubMed, Scopus and Web of Science, encompassing all English-language articles published from inception through March 31, 2025, in accordance with the PRISMA guidelines (PROSPERO ID: CRD420251006821). The search strategy included the following terms: ("shear wave elastography" OR "elastography") AND ("chronic autoimmune thyroiditis" OR "Hashimoto's thyroiditis" OR "diffuse thyroid disease"). Articles were screened for eligibility based on pre-defined inclusion and exclusion criteria. The Newcastle-Ottawa Scale was used to assess the quality of the included studies and ROBINS-I was used to assess the risk of bias. Statistical analysis was performed using the metafor package in R and RevMan software. Statistical significance was defined as α = 0.05. Results Twenty-two studies, comprising a total of 1264 HT patients and 1064 control subjects, were included in our meta-analysis. The pooled estimate using a random-effects model demonstrated significantly higher thyroid stiffness in HT patients compared with controls (mean difference [MD] = 8.36 kPa, 95% confidence interval [CI]: 6.83–9.90, p < 0.001). All studies indicated higher stiffness in HT (all MDs >0), with consistent effect direction despite substantial heterogeneity ( I ² = 93%, τ² = 11.32, p < 0.001) attributable to variations in population characteristics ( e.g. , age, diverse severity, methodology). According to subgroup analysis by age, the diagnostic performance in pediatric populations (MD = 5.06 kPa, 95% CI: 3.78–6.33, p < 0.001) was also reliable, although SWE values were generally lower than in adults (MD = 14.39 kPa, 95% CI: 9.31–19.48, p < 0.001), likely reflecting earlier disease stages or anatomical differences. Newer-generation devices such as the Siemens Acuson S3000 and 2-D-SWE techniques have demonstrated greater sensitivity in detecting fibrotic changes. Conclusion These findings suggest that SWE could serve as a valuable additional diagnostic tool for differentiating HT from normal thyroid tissue, offering a non-invasive method to quantify increased thyroid stiffness associated with disease pathology.