The Presence of Hypoechoic Micronodules in Patients with Hashimoto′s Thyroiditis Increases the Risk of an Alarming Cytological Outcome

The aim of the study was to identify a possible relation between various ultrasonographic (US) appearances of Hashimoto′s thyroiditis (HT) and the risk of obtaining an alarming cytology of coexisting nodules. The study included 557 patients with HT, who had been referred for fine needle aspiration biopsy (FNA). We divided US patterns of HT (UP-HT) into eight groups: (a) Hypoechoic (compared to submandibular glands), homogeneous/fine echotexture
(b) hypoechoic, heterogeneous/coarse echotexture
(c) marked hypoechoic (darker than strap muscles), heterogeneous/coarse echotexture
(d) heterogeneous echotexture with hyperechoic, fibrous septa
(e) multiple, discrete marked hypoechoic areas (sized as 1 to 6 mm)
(f) normoechoic pseudo-nodular areas
(g) echostructure similar to connective tissue
(h) thyroid parenchyma with no signs of HT. Indications for a surgical treatment resulting from the FNA outcome (categories IV–VI of Bethesda System for Reporting Thyroid Cytopathology) were identified only in patients with variants b, c, and e of UP-HT, but merely the “multiple, discrete marked hypoechoic areas” variant significantly increased the odds of obtaining such cytology (OR:5.7). The presence of the “normoechoic pseudo-nodular areas” variant significantly increased the odds for the benign cytology (OR:1.7). There are significant differences in the frequency of obtaining an alarming cytology in relation to the UP-HT variant.