Neck thermography in the differentiation between diffuse toxic goiter during methimazole treatment and normal thyroid
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ENDOCRINE IMAGING
Neck thermography in the differentiation between diffuse toxic goiter during methimazole treatment and normal thyroid Marco Rossato • Marta Burei • Roberto Vettor
Received: 28 April 2014 / Accepted: 14 May 2014 Ó Springer Science+Business Media New York 2014
A 49-year-old woman consulted her general practitioner for typical symptoms of hyperthyroidism. Thyroid function evaluation showed suppressed TSH and elevated FT4 plasma levels. Thyroid ultrasound described mild goiter, with patchy echostructure and a 18 9 6 mm isoechoic nodule at the lower pole of the left lobe, showing intranodular and peripheral vascularization. Treatment with methimazole 5 mg t.i.d. was started and after twenty days the patient required an endocrinological consultation at our Department. At admission patient history and physical examination were typical for Graves’disease. Nonetheless, although the TSH-receptor stimulating antibodies had not been evaluated yet, thyroid scintigraphy could have been of help to differentiate Graves’ disease from toxic nodular goiter, an important distinction for further clinical procedures and treatment. Unfortunately thyroid scintigraphy was not indicated due to methimazole treatment. Thus, we screened the patient’s neck region using a handheld infrared thermal imaging camera (FLIR T450sc, FLIR Systems Inc.) and the neck region of a healthy woman as control. Digital infrared thermal imaging detected many merging large hot spots in the skin overlying the thyroid of the patient (Fig. 1a) that were not present in the healthy subject (Fig. 1b). Different conditions, including Graves’ disease, toxic adenoma, toxic multinodular goiter, and thyroiditis, can cause hyperthyroidism. Generally the clinical diagnosis is confirmed by thyroid function evaluation and morphofunctional characterization. Imaging methods such as radionuclide imaging and ultrasounds are important tools M. Rossato (&) M. Burei R. Vettor Department of Medicine, DIMED, University of Padova, Clinica Medica 3, Padova, Italy e-mail: [email protected]
to characterize the different pathologies causing hyperthyroidism [1]. In our patient clinical and hormonal data were typical for hyperthyroidism, although the presence of a vascularized nodule within the left lobe of the thyroid did not allow the differentiation between Graves’disease or toxic adenoma. Graves’ disease is characterized by diffuse hypervascularized thyroid inducing local high temperature on the overlying neck skin [2]. We evaluated the patient’s neck region with a thermal camera hypothizing that the increased vascular flux characterizing Graves’disease could be still present given the short period of treatment with methimazole. Digital infrared thermal imaging of the neck region of the patient revealed a diffuse patchy temperature elevation of the neck skin overlying the thyroid gland, with a mean increase of 1.9 °C with respect to a healthy control. This observation is suggestive for Graves’ disease then a toxic adenoma as confirmed by successive measurement
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