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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 416-417

Thyroid inferno sign on color doppler: Pathognomic of graves disease


Department of Radio-Diagnosis, JNMC, Wardha, Maharashtra, India

Date of Submission15-Oct-2020
Date of Decision22-Nov-2020
Date of Acceptance31-Dec-2020
Date of Web Publication18-Oct-2021

Correspondence Address:
Dr. Suresh V Phatak
Department of Radio-Diagnosis, JNMC, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_319_20

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How to cite this article:
Harshith Gowda K B, Phatak SV, Raj N, Mano M. Thyroid inferno sign on color doppler: Pathognomic of graves disease. J Datta Meghe Inst Med Sci Univ 2021;16:416-7

How to cite this URL:
Harshith Gowda K B, Phatak SV, Raj N, Mano M. Thyroid inferno sign on color doppler: Pathognomic of graves disease. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Dec 4];16:416-7. Available from: http://www.journaldmims.com/text.asp?2021/16/2/416/328467



Sir,

We present ultrasonography (USG) and color Doppler findings of thyroid gland, exhibiting a pulsatile pattern called “thyroid inferno” in a case of Graves' disease. Graves' disease is an autoimmune disorder which is caused by stimulatory autoantibodies against the thyroid receptor for thyroid-stimulating hormone. This results in the continuous synthesis of excess of T4 and T3.[1] A 30-year-old female presented with the complaints of weight loss, fatigue, increased heart rate, nervousness, and tremors. On examination, she had a warm, moist skin, and her pulse rate was 100 bpm and respiratory rate was 22/min. She was afebrile with a blood pressure of 126/84 mm/Hg. On USG Doppler and color Doppler, the thyroid gland was enlarged, was heterogeneous in echotexture [Figure 1], and was hypervascular showing multiple small areas of color flow, which were present diffusely throughout the gland [Figure 2].
Figure 1: A homogenously enlarged right lobe showing heterogeneous echotexture. No cystic lesion or calcification noted

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Figure 2: Color Doppler with extremely vascular thyroid parenchyma showing thyroid inferno appearance due to arteriovenous shunting

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“Thyroid inferno” is a distinct type of intra-thyroidal color flow pattern noted in patients with Graves' disease. It is a pulsatile type of color flow pattern, wherein multiple, small areas of flow are seen throughout the gland along with mild-to-pronounced color flow in the periphery of the gland. The inferno pattern is not seen in normal subjects or in patients with other thyroid diseases.[2] It should be kept in mind that occasionally, there might be focal hypervascularity similar to a thyroid inferno in patients with Hashimoto's disease.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Girgis CM, Champion BL, Wall JR. Current concepts in graves' disease. Ther Adv Endocrinol Metab 2011;2:135-44.  Back to cited text no. 1
    
2.
Ralls PW, Mayekawa DS, Lee KP, Colletti PM, Radin DR, Boswell WD, et al. Color-flow Doppler sonography in Graves disease: “Thyroid inferno”. AJR Am J Roentgenol 1988;150:781-4.  Back to cited text no. 2
    
3.
Fu X, Guo L, Zhang H, Ran W, Fu P, Li Z, et al. “Focal thyroid inferno” on color Doppler ultrasonography: A specific feature of focal Hashimoto's thyroiditis. Eur J Radiol 2012;81:3319-25.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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