Thyroid scintigraphy is a key imaging modality for diagnosing thyroid disorders. Deep learning models for thyroid scintigraphy classification often face challenges due to limited and imbalanced datasets, leading to suboptimal generalization. In this study, we investigate the effectiveness of different data augmentation techniques including Stable Diffusion (SD), Flow Matching (FM), and Conventional Augmentation (CA) to enhance the performance of a ResNet18 classifier for thyroid condition classification. Our results showed that FM-based augmentation consistently outperforms SD-based approaches, particularly when combined with original (O) data and CA (O+FM+CA), achieving both high accuracy and fair classification across Diffuse Goiter (DG), Nodular Goiter (NG), Normal (NL), and Thyroiditis (TI) cases. The Wilcoxon statistical analysis further validated the superiority of O+FM and its variants (O+FM+CA) over SD-based augmentations in most scenarios. These findings highlight the potential of FM-based augmentation as a superior approach for generating high-quality synthetic thyroid scintigraphy images and improving model generalization in medical image classification.

The objective of this study was to develop an automated pipeline that enhances thyroid disease classification using thyroid scintigraphy images, aiming to decrease assessment time and increase diagnostic accuracy. Anterior thyroid scintigraphy images from 2,643 patients were collected and categorized into diffuse goiter (DG), multinodal goiter (MNG), and thyroiditis (TH) based on clinical reports, and then segmented by an expert. A ResUNet model was trained to perform auto-segmentation. Radiomic features were extracted from both physician (scenario 1) and ResUNet segmentations (scenario 2), followed by omitting highly correlated features using Spearman's correlation, and feature selection using Recursive Feature Elimination (RFE) with XGBoost as the core. All models were trained under leave-one-center-out cross-validation (LOCOCV) scheme, where nine instances of algorithms were iteratively trained and validated on data from eight centers and tested on the ninth for both scenarios separately. Segmentation performance was assessed using the Dice similarity coefficient (DSC), while classification performance was assessed using metrics, such as precision, recall, F1-score, accuracy, area under the Receiver Operating Characteristic (ROC AUC), and area under the precision-recall curve (PRC AUC). ResUNet achieved DSC values of 0.84$\pm$0.03, 0.71$\pm$0.06, and 0.86$\pm$0.02 for MNG, TH, and DG, respectively. Classification in scenario 1 achieved an accuracy of 0.76$\pm$0.04 and a ROC AUC of 0.92$\pm$0.02 while in scenario 2, classification yielded an accuracy of 0.74$\pm$0.05 and a ROC AUC of 0.90$\pm$0.02. The automated pipeline demonstrated comparable performance to physician segmentations on several classification metrics across different classes, effectively reducing assessment time while maintaining high diagnostic accuracy. Code available at: https://github.com/ahxmeds/thyroidiomics.git.