Graves' Disease Thyroid Color-Flow Doppler Ultrasonography Assessment: Review Article


Graves’ disease, as known today, is an autoimmune, diffuse, chronic disease of thyroid gland, as described by Robert Graves in 1835. It presents genetic predisposition and unknown etiology evidence, which is influenced in its development by several factors, including environment (dietary iodine intake, stress, drugs and infections). The disease is characterized by one or more changes: hyperthyroidism, goiter, ophthalmopathy, skin changes and pretibial myxedema, around 5% less common, and other symptoms 90% to 95%. One of the most relevant clinical practice aspects in Graves’ disease patients management is to distinguish Graves’ disease in initial phase, from other types of destructive thyrotoxicosis, in addition to evaluate therapeutic methods and efficient follow up, as well as predict early recurrence or remission of disease. Scintigraphy with pertechnetate (99 mTc) and TSH levels dosage are considered the choice for this purpose. However, they present some technical difficulties, as they are not widely available and have contraindications. In this scenario, thyroid color-flow doppler ultrasonography (US Doppler) presents a viable alternative, as a widely available, low cost, non-invasive and radiation free method, providing initial diagnosis and patients with Graves’ disease follow up. In adittion, this method is used in differential diagnosis with other causes of thyrotoxicosis in the early stage.

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dos Santos, T. , Pina, R. , de Souza, M. and Chammas, M. (2014) Graves' Disease Thyroid Color-Flow Doppler Ultrasonography Assessment: Review Article. Health, 6, 1487-1496. doi: 10.4236/health.2014.612183.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Graves, R.J. (1835) Newly Observed Affection of the Thyroid. London Medical and Surgical Journal, 7, 515.
[2] Weetman, A.P. (2000) Graves’ Disease. The New England Journal of Medicine, 343, 1236-1248.
[3] Vieira, L.O., Kubo, R., Sapienza, M.T., Willegaignon, J., Chammas, M.C., Coura-Filho, G.B., Ono, C.R., Watanabe, T., Sado, H.N. and Buchpiguel, C.A. (2011) Correlação entre Volume Tireoidiano Determinado pelo Método de Ultrassonografia Versus Cintilografia e sua Implicação em Cálculos Dosimétricos na Terapia com Radioiodo na Doença de Graves. Arquivos Brasileiros de Endocrinologia & Metabologia, 55, 9.
[4] Davies, T.F. (1992) New Thinking on the Immunology of Graves’ Disease. Thyroid Today, 15, 1-11.
[5] Andrade, V.A., Gross, J.L. and Maia, A.L. (2001) Tratamento do Hipertiroidismo da Doença de Graves. Arquivos Brasileiros de Endocrinologia & Metabologia, 45, 609-618.
[6] Zuhur, S.S., Ozel, A., Kuzu, I., Erol, R.S., Ozcan, N.D., Okcan, B., Yenici, F.U. and Altuntas, Y. (2013) The Diagnostic Utility of Color Doppler Ultrasonography, Tc-99m Pertechnetate Uptake and TSH Receptor Antibody for Differential Diagnosis between Graves’ Disease and Silent Thyroiditis: A Comparative Study. Subject Health Services, Medical Sciences and Endocrinology, 20, 310-319.
[7] Chen, L., Zhao, X., Liu, H., Wang, Y., Li, L., Lu, B., Li, Y. and Hu, R. (2012) Mean Peak Systolic Velocity of the Superior Thyroid Artery Is Correlated with Radioactive Iodine Uptake in Untreated Thyrotoxicosis. Journal of International Medical Research, 40, 640-647.
[8] Donkol, R.H., Nada, A.M. and Boughattas, S. (2013) Role of Color Doppler in Differentiation of Graves’ Disease and Thyroiditis in Thyrotoxicosis. World Journal of Radiology, 5, 178-183.
[9] Alzahrani, A.S., Ceresini, G. and Aldasouqui, S.A. (2012) Role of Ultrasonography in the Differential Diagnosis of Thyrotoxocosis: A Noninvasive, Cost-Effective, and Widely Available but Underutilized Diagnostic Tool. Endocrine Practice, 18, 567-578.
[10] Hari Kumar, K.V.S., Vamsikrishna, P., Verma, A., Muthukrishnan, J., Ramasubba Rayudu, B. and Modi, K.D. (2009) Utility of Colour Doppler Sonography in Patients with Graves’ Disease. West Indian Medical Journal, 58, 566-570.
[11] Zuhur, S.S., Özel, A., Velet, S., Bugdaci, M.S., Çil, E. and Altuntas, Y. (2012) Is the Measurement of Inferior Thyroid Artery Blood Flow Velocity by Color-flow Doppler Ultrasonography Useful for Differential Diagnosis between Gestational Transient Thyrotoxicosis and Graves’ Disease? A Prospective Study. Clinics, 67, 125-129.
[12] Karakas, O., Karakas, E., Cullu, N., Demir, Y., Kucukyavas, Y., Surucu, E., Yener, S. and Igci, E. (2014) An Evaluation of Thyrotoxic Autoimmune Thyroiditis Patients with Triplex Doppler Ultrasonography. Clinical Imaging, 38, 1-5.
[13] Zhao, X., Chen, L., Li, L., Wang, Y., Wang, Y., et al. (2012) Peak Systolic Velocity of Superior Thyroid Artery for the Differential Diagnosis of Thyrotoxicosis. PLoS ONE, 7, Article ID: e50051.
[14] Solbiati, L., Rizzatto, G. and Charboneau, J.W. (1995) Ultrasound of Superficial Structures-High Frequencies, Doppler and Interventional Procedures. Churchill Livingstone, New York.
[15] Macedo, T.A.A. (2006) Distinção entre os Tipos 1 e 2 de Tireotoxicose Associada à Amiodarona por Meio de Dúplex-Doppler Colorido. Doutorado, Universidade de São Paulo, São Paulo.
[16] Vitti, P. (2000) Grey Scale Thyroid Ultrasonography in the Evaluation of Patients with Graves’ Disease. European Journal of Endocrinology, 142, 22-24.
[17] Höfling, D.B., Cerri, G.G., Juliano, A.G., Marui, S. and Chammas, M.C. (2008) Value of Thyroid Echogenicity in the Diagnosis of Chronic Autoimmune Thyroiditis. Radiologia Brasileira, 41, 409-417.
[18] Vitti, P., Rago, T., Mancusi, F., Pallini, S., Tonacchera, M., Santini, F., et al. (1992) Thyroid Hypoechogenic Pattern at Ultrasonography as a Tool for Predicting Recurrence of Hyperthyroidism after Medical Treatment in Patients with Graves’ Disease. Acta Endocrinologica, 126, 128-131.
[19] Ralls, P.W., Mayekawa, D.S., Lee, K.P., Colletti, P.M., Radin, D.R., Bosnell, W.D., et al. (1988) Color-Flow Doppler Sonography in Graves’ Disease: “Thyroid Inferno”. American Journal of Roentgenology, 150, 781-784.
[20] Vitti, P., Rago, T., Mazzeo, S., et al. (1995) Thyroid Blood Flow Evaluation by Color-Flow Doppler Sonography Distinguishes Graves’ Disease from Hashimoto’s Thyroiditis. Journal of Endocrinological Investigation, 18, 857-862.
[21] Macedo, T.A., Chammas, M.C., Jorge, P.T., Pereira de Souza, L., Farage, L., Pegoraro, B.L., Pessa, S.U. and Cerri, G.G. (2007) Reference Values for Doppler Ultrasound Parameters of the Thyroid in a Healthy Iodine-Non-Deficient Population. The British Journal of Radiology, 80, 625-630.
[22] Kurita, S., Sakurai, M., Kita, Y., Ota, T. and Ando, H. (2005) Measurement of Thyroidal Blood Flow Area Is Useful for Diagnosing the Cause of Thyrotoxicosis. Thyroid, 11, 1249-1252.
[23] Phillips, B.D. and Hennessey, J.V. (2009) Iodinated Contrast Prior to Evaluation for Thyrotoxicosis. Journal of Hospital Medicine, 4, 285-288.
[24] Hari Kumar, K.V., Pasupuleti, V., Jayaraman, M., Abhyuday, V., Rayudu, B.R. and Modi, K.D. (2009) Role of Thyroid Doppler in Differential Diagnosis of Thyrotoxicosis. Endocrine Practice, 15, 6-9.
[25] Chammas, M.C., Saito, O.C. and Cerri, C.C. (1999) Tireoide. In: Saito, O.C. and Cerri, G.G., Eds., Ultra-Songorafia Pequenas Partes, Savier, São Paulo, 14-55.

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