{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:13:54Z","timestamp":1793121234647,"version":"4.5.0"},"reference-count":31,"publisher":"Korean Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-enm.org"],"crossmark-restriction":true},"short-container-title":["Endocrinol Metab"],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:p>Background: Thyrotoxicosis presents significant diagnostic challenges in distinguishing Graves\u2019 disease (GD) from destruction-induced thyrotoxicosis (DT) using ultrasound imaging. We evaluated a new technology, microvascular ultrasonography (MVUS) to effectively differentiate between GD and DT, and observe the MVUS changes during follow-up.Methods: A total of 264 consecutive patients were prospectively enrolled into two cohorts from August 2022 to March 2024 at one tertiary referral hospital: cohort 1 comprised patients initially presenting with thyrotoxicosis (n=185; 98 with GD and 87 with DT). Cohort 2 included patients either with GD considering antithyroid drug discontinuation or with DT in the follow-up phase after treatment (n=77). Ultrasound imaging was conducted using the MVUS technique, and the vascularity index (MVUS-VI) was automatically calculated as the percentage ratio of color pixels to total grayscale pixels within a specified region of interest.Results: Diagnostic accuracy highlighted MVUS-VI as the most accurate diagnostic tool, achieving a sensitivity of 79.6%, specificity of 84.3%, with an area under the curve of 0.856 (95% confidence interval, 0.800 to 0.911). Presence of thyroid peroxidase antibody or thyroglobulin antibody affected MVUS-VI\u2019s performance, requiring a higher cut-off value for specificity in this subgroup. Follow-up in cohort 2 (n=77) demonstrated significant normalization in thyroid function and reductions in MVUS-VI from an initial 32.6%\u00b123.4% to 20.8%\u00b113.5% at follow-up (P&lt;0.001).Conclusion: MVUS-VI provides a rapid, non-invasive diagnostic alternative to traditional methods in differentiating GD from DT, thus aiding in the management of patients with thyrotoxicosis.<\/jats:p>","DOI":"10.3803\/enm.2024.2206","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T23:49:56Z","timestamp":1740527396000},"page":"394-404","update-policy":"https:\/\/doi.org\/10.3803\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Microvascular Ultrasonography Vascularity Index as a Rapid and Simplified Assessment Tool for Differentiating Graves\u2019 Disease from Destructive Thyroiditis and Managing Thyrotoxicosis"],"prefix":"10.3803","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6896-9024","authenticated-orcid":true,"given":"Han-Sang","family":"Baek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaiho","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeonghoon","family":"Ha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0995-6482","authenticated-orcid":true,"given":"Dong-Jun","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2119","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.4183\/aeb.2019.416"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-019-0388-x"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvac023"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa646"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3803\/enm.2022.1413"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15171"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.4329\/wjr.v5.i4.178"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1363282"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.4158\/ep11170.ra"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.11.7009"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s11547-023-01679-6"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15008"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.3803\/enm.2023.1664"},{"key":"ref14","volume-title":"Sample size calculator [Internet]","author":"Arifin","year":"2024"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1996.tb03538.x"},{"key":"ref16","first-page":"205","volume-title":"","author":"Vitti","year":"2018"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.3390\/ijms150712895"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.4097\/kja.21209"},{"key":"ref19","first-page":"48","volume-title":"Part 1: Simple definition and calculation of accuracy, sensitivity and specificity","author":"Baratloo","year":"2015"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgae254"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1999.9.1189"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1997.7.823"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz292"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.k07e-052"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1300447"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12880-021-00697-y"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15819"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1007\/s40477-024-00898-5"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1186\/s13244-024-01806-5"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.2000.01504.x"}],"container-title":["Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-enm.org\/upload\/pdf\/enm-2024-2206.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-enm.org\/journal\/view.php?doi=10.3803\/EnM.2024.2206","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-enm.org\/upload\/pdf\/enm-2024-2206.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:10:43Z","timestamp":1751242243000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-enm.org\/journal\/view.php?doi=10.3803\/EnM.2024.2206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.3803\/enm.2024.2206","relation":{},"ISSN":["2093-596X","2093-5978"],"issn-type":[{"value":"2093-596X","type":"print"},{"value":"2093-5978","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]},"assertion":[{"value":"2024-10-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-25","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}