{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:32:02Z","timestamp":1790983922081,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5\u201315 MHz linear probe). Five valid measurements for the parenchyma\/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 \u00b1 2.11 vs. 1.03 \u00b1 0.51; p &lt; 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 \u00b1 2.53 vs. 2.15 \u00b1 1.27, p &lt; 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis.<\/jats:p>","DOI":"10.3390\/diagnostics10110874","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T11:43:06Z","timestamp":1603885386000},"page":"874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["The Value of Strain Elastography in Predicting Autoimmune Thyroiditis"],"prefix":"10.3390","volume":"10","author":[{"given":"Cristina Mihaela","family":"Cepeha","sequence":"first","affiliation":[{"name":"PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9040-2297","authenticated-orcid":false,"given":"Corina","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6046-9191","authenticated-orcid":false,"given":"Andreea","family":"Borlea","sequence":"additional","affiliation":[{"name":"PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-0303","authenticated-orcid":false,"given":"Florin","family":"Borcan","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Fofiu","sequence":"additional","affiliation":[{"name":"PhD School Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Adriana","family":"Dehelean","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3826-4362","authenticated-orcid":false,"given":"Dana","family":"Stoian","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1507\/endocrj.EJ19-0234","article-title":"Comprehensive research on thyroid diseases associated with autoimmunity: Autoimmune thyroid diseases, thyroid diseases during immune-checkpoint inhibitors therapy, and immunoglobulin-G4-associated thyroid diseases","volume":"66","author":"Inaba","year":"2019","journal-title":"Endocr. J."},{"key":"ref_2","unstructured":"Feingold, K.R., Anawalt, B., Boyce, A., Chrousos, G., and Dungan, K. (2017). Hashimoto\u2019s thyroiditis. Endotext [Internet], MDText.com, Inc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/bmb\/ldr030","article-title":"Vanderpump, The epidemiology of thyroid disease","volume":"99","author":"Mark","year":"2011","journal-title":"Br. Med. Bull."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1210\/er.2006-0043","article-title":"The clinical significance of subclinical thyroid dysfunction","volume":"29","author":"Biondi","year":"2008","journal-title":"Endocr. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/0090-1229(86)90174-1","article-title":"Effect of testosterone treatments for varying periods on autoimmune development and on specific infiltrating leukocyte populations in the thyroid gland of obese strain chickens","volume":"39","author":"Gause","year":"1986","journal-title":"Clin. Immunol. Immunopathol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1089\/105072502761016458","article-title":"Epidemiology and prevention of clinical and subclinical hypothyroidism","volume":"12","author":"Vanderpump","year":"2002","journal-title":"Thyroid"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1210\/jcem-51-5-1123","article-title":"Changes in thyroid function in euthyroid subjects with a family history of Graves\u2019 disease: A follow-up study of 69 patients","volume":"51","author":"Tamai","year":"1980","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_8","first-page":"4656","article-title":"Mapping the major susceptibility loci for familial Graves\u2019 and Hashimoto\u2019s diseases: Evidence for genetic heterogeneity and gene interactions","volume":"84","author":"Tomer","year":"1999","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0041-111275","article-title":"Die Bedeutung der Sonografiebei der Abkl\u00e4rung von Schilddr\u00fcsenerkrankungen [Ultrasound of the Thyroid]","volume":"95","author":"Dietrich","year":"2016","journal-title":"Laryngorhinootologie"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.11152\/mu-980","article-title":"Thyroid Ultrasound: State of the Art Part 1\u2014Thyroid Ultrasound reporting and Diffuse Thyroid Diseases","volume":"19","author":"Dighe","year":"2017","journal-title":"Med. Ultrason."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.2741\/4437","article-title":"Ultrasonography in the diagnosis of Hashimoto\u2019s thyroiditis","volume":"21","author":"Wu","year":"2016","journal-title":"Front. Biosci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.ejrad.2013.05.008","article-title":"Ultrasound elastography in the evaluation of thyroid pathology. Current status","volume":"83","author":"Cantisani","year":"2014","journal-title":"Eur. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Stoian, D., Bogdan, T., Craina, M., Craciunescu, M., Timar, R., and Schiller, A. (2016). Elastography: A new ultrasound technique in nodular thyroid pathology. Thyroid Cancer Adv. Diagn. Ther.","DOI":"10.5772\/64374"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Havre, R., Waage, J., Gilja, O., \u00d8degaard, S., and Nesje, L. (2011). Real-Time Elastography: Strain Ratio Measurements Are Influenced by the Position of the Reference Area. Ultraschall Med. Eur. J. Ultrasound.","DOI":"10.1055\/s-0031-1273247"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.7150\/thno.18650","article-title":"Ultrasound Elastography: Review of Techniques and Clinical Applications","volume":"7","author":"Sigrist","year":"2017","journal-title":"Theranostics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"645","DOI":"10.17219\/acem\/26301","article-title":"Ultrasound Elastography\u2014Review of Techniques and its Clinical Applications","volume":"23","author":"Kaczorowski","year":"2014","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1089\/thy.2010.0079","article-title":"Real-Time Elastography for the Differentiation of Benign and Malignant Thyroid Nodules: A Meta-Analysis","volume":"20","author":"Bojunga","year":"2010","journal-title":"Thyroid"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"327","DOI":"10.11152\/mu.2013.2066.173.dst","article-title":"Thyroid Imaging Reporting and Data System (TI-RADS): The impact of quantitative strain elastography for better stratification of cancer risks","volume":"17","author":"Stoian","year":"2015","journal-title":"Med. Ultrason."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"495","DOI":"10.7863\/ultra.33.3.495","article-title":"Real-time Ultrasound Elastography for Differentiation of Benign and Malignant Thyroid Nodules","volume":"33","author":"Sun","year":"2014","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1055\/s-0033-1335375","article-title":"EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications","volume":"34","author":"Cosgrove","year":"2013","journal-title":"Ultraschall Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kara, T., Ate\u015f, F., and Durmaz, M.S. (2020). Assessment of thyroid gland elasticity with shear-wave elastography in Hashimoto\u2019s thyroiditis patients. J. Ultrasound.","DOI":"10.1007\/s40477-020-00437-y"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.clinimag.2018.03.019","article-title":"The value of shear wave elastography in diffuse thyroid disease","volume":"49","author":"Liu","year":"2018","journal-title":"Clin. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"993","DOI":"10.3906\/sag-1803-235","article-title":"Value of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology","volume":"48","year":"2018","journal-title":"Turk. J. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.ultrasmedbio.2018.02.005","article-title":"Role of Virtual Touch Tissue Quantification in Hashimoto\u2019s Thyroiditis","volume":"44","author":"Lin","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1016\/j.ultrasmedbio.2015.07.012","article-title":"Assessment of Diffuse Thyroid Disease by Strain Ratio in Ultrasound Elastography","volume":"41","author":"Yang","year":"2015","journal-title":"Ultrasound Med. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20140604","DOI":"10.1259\/bjr.20140604","article-title":"The value of real-time ultrasound elastography in chronic autoimmune thyroiditis","volume":"87","author":"Menzilcioglu","year":"2014","journal-title":"Br. J. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.18203\/2320-6012.ijrms20191489","article-title":"Elastography evaluation of normal thyroid gland and its comparison with diffuse non nodular enlarged thyroid gland using strain ultrasound elastography","volume":"7","author":"Kumar","year":"2019","journal-title":"Int. J. Res. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.autrev.2014.01.007","article-title":"Hashimoto thyroiditis: Clinical and diagnostic criteria","volume":"13","author":"Caturegli","year":"2014","journal-title":"Autoimmun. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sedlackova, Z., Herman, J., and Furst, T. (2020). Share wave elastography in diffuse thyroid disease. Biomed. Pap.","DOI":"10.5507\/bp.2020.018"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.3349\/ymj.2014.55.1.247","article-title":"Diagnostic Role of Conventional Ultrasonography and ShearwaveElastography in Asymptomatic Patients with Diffuse Thyroid Disease: Initial Experience with 57 Patients","volume":"55","author":"Kim","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"322","DOI":"10.11152\/mu.2013.2066.173.khu","article-title":"The role of shear wave elastography in the diagnosis of chronic autoimmune thyroiditis","volume":"17","author":"Hekimoglu","year":"2015","journal-title":"Med. Ultrason."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1016\/j.ultrasmedbio.2014.03.033","article-title":"Real-Time Elastography in the Evaluation of Diffuse Thyroid Disease: A Study Based on Elastography Histogram Parameters","volume":"40","author":"Yoon","year":"2014","journal-title":"Ultrasound Med. Biol."},{"key":"ref_33","first-page":"e22019","article-title":"Value of Real-Time and Strain Ratio Elastography in Differential Diagnosis of Graves\u2019 Disease and Subacute and Hashimoto\u2019s Thyroiditis","volume":"14","author":"Korkmaz","year":"2017","journal-title":"Iran. J. Radiol."},{"key":"ref_34","first-page":"7534","article-title":"Real-time ultrasound elastography evaluation of the thyroid gland in adolescent patients with hashimoto thyroiditis","volume":"28","author":"Parlak","year":"2017","journal-title":"Biomed. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Fukuhara, T., Matsuda, E., Izawa, S., Fujiwara, K., and Kitano, H. (2015). Utility of Shear Wave Elastography for Diagnosing Chronic Autoimmune Thyroiditis. J. Thyroid Res., 1\u20135.","DOI":"10.1155\/2015\/164548"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.ultrasmedbio.2015.03.007","article-title":"WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver","volume":"41","author":"Ferraioli","year":"2015","journal-title":"Ultrasound Med. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/jum.14856","article-title":"Review of Liver Elastography Guidelines","volume":"38","author":"Ferraioli","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1002\/hep.29179","article-title":"Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis","volume":"67","author":"Herrmann","year":"2018","journal-title":"Hepatology"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Grosu, I., Bob, F., Sporea, I., Popescu, A., Sirli, R., and Schiller, A. (2019). Two-Dimensional Shear-Wave Elastography for Kidney Stiffness Assessment. Ultrasound Q.","DOI":"10.1097\/RUQ.0000000000000461"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/RUQ.0000000000000404","article-title":"Ultrasound Elastography Evaluations in Patient Populations With Various Kidney Diseases","volume":"35","author":"Gungor","year":"2019","journal-title":"Ultrasound Q."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2646","DOI":"10.1056\/NEJMra021194","article-title":"Thyroiditis","volume":"348","author":"Pearce","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S0046-8177(78)80028-8","article-title":"The pathology of thyroiditis","volume":"9","year":"1978","journal-title":"Hum. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/j.1365-2265.2011.04170.x","article-title":"Shear wave elastography in the diagnosis of thyroid nodules: Feasibility in the case of coexistent chronic autoimmune Hashimoto\u2019s thyroiditis","volume":"76","author":"Magri","year":"2011","journal-title":"Clin. Endocrinol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/11\/874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:29:24Z","timestamp":1760178564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/11\/874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,27]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["diagnostics10110874"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics10110874","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,27]]}}}