The value of thyroid parenchymal echogenicity as an indicator of pathology using the sternomastoid muscle for comparison

This study was undertaken to evaluate the diagnostic accuracy of comparison of the echogenicity of the thyroid gland with the sternomastoid muscle in diagnosis of thyroid disorders. Fifty healthy subjects underwent a thyroid ultrasound, and 80 patients with archived thyroid ultrasound examinations (50 thyrotoxicosis and 30 thyroiditis) were reviewed. Images were measured for the image density of the thyroid gland and the sternomastoid muscle, using a transmission densitometer. Healthy thyroid was relatively hyperechoic when compared with the sternomastoid muscle (100%). Of the thyrotoxic patients, 70% showed a relatively hyperechoic thyroid compared to 47% of the thyroiditis patients. Mean image density difference in healthy thyroid, thyrotoxicosis and thyroiditis ranged from 0.1 to 1, -0.42 to 0.83, and -0.55 to 0.58, respectively. In conclusion, the relative echogenicity of the thyroid gland when compared with the sternomastoid muscle may be useful to differentiate healthy thyroid from thyrotoxicosis and thyroiditis, but does not help to distinguish thyrotoxicosis from thyroiditis. An image density difference of less than 0.1 may be considered to be abnormal, whereas a value greater than 0.83 may be considered to be normal.