Stages of Hashimoto's Thyroiditis: Key Ultrasound & color Doppler Findings Across Stages

Hashimoto's thyroiditis presents with distinct ultrasound and Doppler findings across its stages. In the micronodular stage, the thyroid appears heterogeneous with a characteristic "giraffe-like" pattern of small hypoechoic nodules. Moderate vascularity is noted, reflecting early inflammation. As the disease progresses, the markedly vascular stage shows an enlarged thyroid with intense hypervascularity, sometimes mimicking Graves’ disease. Doppler imaging reveals a “thyroid inferno” pattern, indicating significant blood flow throughout the gland, often accompanied by transient hyperthyroid symptoms (hashitoxicosis). In the atrophic stage, the gland becomes severely shrunken, hypoechoic, and barely distinguishable on ultrasound. However, color Doppler imaging can still detect feeble vascularity, aiding in identifying the remnant thyroid tissue despite its profound atrophy.
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