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thyriod gland HYPOTHYRIODISM imaging part 4 (hypothyriodism) Dr Ahmed Esawy

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thyriod gland HYPOTHYRIODISM imaging part 4 (hypothyriodism) dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound images
INDICATIONS FOR PERFORMING ULTRASOUND-GUIDED FNA BIOPSY OF A THYROID NODULE
GOITRE
FOCAL/NODULAR MULTINODULAR UNINODULAR
TOXIC NODULE
INACTIVE
COLD
TOXIC NODULE
TOXIC MULTINODULAR GIOTRE
INACTIVE
COLD
DIFFUSE GIOTRE
Hshimoto s thyroiditis
Graves disease
Subacute thyroiditis
Suppurative thyroiditis
Drug-induced thyroiditis
Riedel s thyroiditis
Iodine deficiency
Organification defect
Radiotion exposure
pregnant ,menopause thyroiditis
Silent thyrioditis/post partum thyroiditis
Cold Thyroid Nodule
 BENIGN TUMOR
 Nonfunctioning adenoma
 Cyst (11–20%)
 Involutional nodule
 Parathyroid tumor
 INFLAMMATORY MASS
 Focal thyroiditis
 Granuloma
 Abscess
 MALIGNANT TUMOR
 Carcinoma
 Lymphoma
 Metastasis
 BENIGN NODULAR GIOTRE
 NEOPLASM
 Benign thyroid cysts (degenerated nodules)
 Simple cyst
 Haemorrhagic Cystic nodule in solid tumour
 COLLIOD
 Dominent colliod nodule in MNG
 uninodular
 Adenoma
 macrofollicular (simple colliod)
 microfollicular (fetal)
 embryonal (trabecular)
 hurthe cell adenoma
 atypical adenoma
 adenoma with papillae
 signet ring adenoma
 Inflammatory disorder
 subacute thyrioditis
 lymphocystic thyrioditis
 granulomatous disease
 (sarciodosis/TB)
 abscess
 developmental
 dermiod
 unilateral lobe agenesis
 MALIGNANT NODULAR GIOTRE
 MALIGNANT
 Papillary carcinoma
 Follicular carcinoma
 Hurthle cell tumor
 Medullary Thyroid Carcinoma
 Anaplastic Carcinoma
 Lymphoma of thyroid
 HYPOTHYRIODISM
 CONGENITAL
 Hypoplasia & mal-descent
 Agenesis ,hemiagenesis
 Ectopia thyriod (sublingual thyriod)
 Familial enzyme defects
 Iodine deficiency (endemic cretinism)
 Intake of goitrogens during pregnancy
 Pituitary defects
 Idiopathic
 ACQUIRED
 Iodine deficiency(diffuse giotre)
 Hashimoto´s thyroiditis (autoimmune thyroiditis)
 Subacute (De Quervein’s) thyroiditis
 Thyroidectomy or RAI therapy
 TSH or TRH deficiency
 Medications (iodide & Cobalt,amiodarone))
 Idiopathic
 Post partum
 amyliodosis
 COMMON CAUSES OF HYPERTHYROIDISM
 autoimmune diseases
Graves disease (the most common cause of
hyperthyroidism
Lymphocytic thyroiditis With hyperthyroidism
(silent thyroiditis)
Postpartum thyrotoxicosis (PPT)
 functioning thyroid adenomas (Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer's disease)
 Toxic multinodular goiter


Published in: Health & Medicine
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thyriod gland HYPOTHYRIODISM imaging part 4 (hypothyriodism) Dr Ahmed Esawy

  1. 1. ‫الرحمن‬ ‫هللا‬ ‫بسم‬ ‫الرحيم‬ Dr Ahmed Esawy
  2. 2. Dr. Ahmed Eisawy MBBS M.Sc MD Dr Ahmed Esawy
  3. 3. HYPOTHYRIODISM CONGENITAL Hypoplasia & mal-descent Agenesis ,hemiagenesis Ectopia thyriod (sublingual thyriod) Familial enzyme defects Iodine deficiency (endemic cretinism) Intake of goitrogens during pregnancy Pituitary defects Idiopathic Iodine deficiency(diffuse giotre) Hashimoto´s thyroiditis (autoimmune thyroiditis) Subacute (De Quervein’s) thyroiditis Thyroidectomy or RAI therapy TSH or TRH deficiency Medications (iodide & Cobalt,amiodarone)) Idiopathic Post partum amyliodosis ACQUIRED Dr Ahmed Esawy
  4. 4. Thyriod Ultrasound in hypothyriodism Dr Ahmed Esawy
  5. 5. Causes of Congenital Hypothyroidism • Dysgenesis ectopic thyriod (Sublingual thyroid) Agenesis Hypoplasia Hemiagenesis Dr Ahmed Esawy
  6. 6. Causes of Acquired Hypothyroidism • Postoperative states • Iodine deficiency (diffuse goitre which often becomes nodular . The perfusion is normal. Enlargement of the thyroid gland is an adaptive process in low iodine intake) • Hashimoto´s thyroiditis (autoimmune thyroiditis) • Subacute (De Quervein’s) thyroiditis • Amiodarone-induced hypothyroidism • Post partum • Amyliodosis infiltration Dr Ahmed Esawy
  7. 7. Causes of Acquired Hypothyroidism • Postoperative states • Iodine deficiency (diffuse goitre which often becomes nodular . The perfusion is normal. Enlargement of the thyroid gland is an adaptive process in low iodine intake) • Hashimoto´s thyroiditis (autoimmune thyroiditis) • Subacute (De Quervein’s) thyroiditis • Amiodarone-induced hypothyroidism • Post partum • Amyliodosis infiltration Dr Ahmed Esawy
  8. 8. State of thyriod blood perfusion Perfusion of the thyroid increases on several occasions: • increased cardiac output (a stressed patient), • in gravidity, • during an active autoimmune inflammation – active Graves´ disease or Hashimoto´s thyroiditis ((in active Graves´ disease “thyroid inferno”). • hyperfunctioning nodules • untreated primary hypothyroidism because of TSH stimulation. decreased perfusion in breakdown of the thyroid tissue – as is the case of • postpartum thyroiditis, • De Quervain thyroiditis • amiodarone-induced thyrotoxicosis type 2. Dr Ahmed Esawy
  9. 9. • PSV normal up to 25 cm/sec • PSV at thyrotoxicosis more than 100 cm/sec • PSV at hypothyriodism 50-60 cm/sec Dr Ahmed Esawy
  10. 10. Normal thyroid gland : US Dr Ahmed Esawy
  11. 11. TUS of a diffuse goitre in a euthyroid patient Dr Ahmed Esawy
  12. 12. Normal TUS image of left thyroid lobe (euthyroid patient with negative thyroid autoantibodies). Note the low perfusion on the Doppler imaging (right). Dr Ahmed Esawy
  13. 13. Reference Standard for Thyroid Size (cm) by Age Dr Ahmed Esawy
  14. 14. 10-day-old girl with sublingual thyroid gland. . Dr Ahmed Esawy
  15. 15. 14-day-old girl with thyroid agenesis. Dr Ahmed Esawy
  16. 16. 7-day-old boy with thyroid hemiagenesis. Dr Ahmed Esawy
  17. 17. 20-day-old girl with hemiagenesis and sublingual thyroid. . Dr Ahmed Esawy
  18. 18. 9-day-old boy with thyroid gland in normal location. Dr Ahmed Esawy
  19. 19. Congenital hypothyroidism Ultrasound Aplasia Hemiagenesis Lingual thyroid Dr Ahmed Esawy
  20. 20. Dr Ahmed Esawy
  21. 21. Hashimotos thyroiditis • Destructive autoimmune disorder which leads to chronic inflammation of gland • Enlargment not necessarly symmetric • Young Middle aged female Dr Ahmed Esawy
  22. 22. Hashimotos thyroiditis • Three stages • -Acute : enlarged in size and decreased vascularity • Chronic : enlarged with multiple linear bright echoes throuhout parenchyma with multiple hypoechioc nodules • Atrophic : end stage small atrophic gland ,avascular with heterogenous echoes Dr Ahmed Esawy
  23. 23. Hashimotos thyroiditis • Sonographic features : • diffusle enlarged and coarse parenchyma • heterogenous texture • Multiple hypoechioc nodules in both lobes Dr Ahmed Esawy
  24. 24. Hashimotos thyroiditis Dr Ahmed Esawy
  25. 25. Hashimotos thyroiditis (late stage): Heterogeneous and coarse parenchyma • Multiple small hypoechoic nodules surrounded by an echogenic rim of fibrosis • Vascularity : Variable; increased early in the disease and decreased later in the disease course Dr Ahmed Esawy
  26. 26. diffusely coarse echotexture with innumerable tiny hypoechoic nodules that may become confluent, interspersed with echogenic fibrous bands. Vascularity may be increased, decreased, or normal, and FNA is usually not necessary for diagnosis. painless enlarged thyroid usually in a hypothyroid state .few in hyperthyriod state Hashimotos thyroiditis Dr Ahmed Esawy
  27. 27. Nodular Hashimotos thyroiditis Homogeneously echogenic nodule with a hypoechoic rim: “white knight” Dr Ahmed Esawy
  28. 28. Typical TUS image of Hashimoto´s thyroiditis (TSH 17 mIU/l, highly positive thyroid autoantibodies). Note the inhomogenous and hypoechogenic thyroid texture. Dr Ahmed Esawy
  29. 29. TUS image of the right thyroid lobe in a patient with Hashimoto´s thyroiditis with a large goitre. Dr Ahmed Esawy
  30. 30. Graves disease Diffusely enlarged, hypoechoic, increased vascularity (thyroid inferno) Dr Ahmed Esawy
  31. 31. Graves disease • PSV HIGH Dr Ahmed Esawy
  32. 32. Graves disease / Hashimotos thyroiditis Thyroid inferno Graves disease: 4 hour uptake of 40% Dr Ahmed Esawy
  33. 33. Absent thyroid gland in a patient after total thyroidectomy due to papillary thyroid carcinoma. Note fibrous tissue without residual thyroid parenchyma in the thyroid beds.Dr Ahmed Esawy
  34. 34. atrophic thyroiditis TUS of atrophic thyroiditis (a patient with mild hypothyroidism: TSH 9.43 mIU/l, highly positive anti-TPO antibodies). Dr Ahmed Esawy
  35. 35. Subacute (De Quervein’s) thyroiditis • The inflammation do not involve entire glan but infiltrates gland in non- homogenous patteren • Sonographic feature (hypoechioc and hypervascular areas) Dr Ahmed Esawy
  36. 36. TUS image of subacute thyroiditis in the hyperthyroid phase (FT3: 10.7 pmol/l, FT4: 33.1 pmol/l, TSH: 0.039 mIU/l, antibodies negative). Note the low perfusion as shown by the Doppler imaging (right). Dr Ahmed Esawy
  37. 37. amiodarone TUS image in a 69-year-old patient who developed hypothyroidism after treatment by amiodarone. Dr Ahmed Esawy
  38. 38. Post partum TUS of the left thyroid lobe of patient with PPT which occurred two months after delivery . Four months after delivery, the patient developed hypothyroidism Dr Ahmed Esawy
  39. 39. euthyroid woman TUS image in a young euthyroid woman with negative antithyroid antibodies Dr Ahmed Esawy
  40. 40. amyloidosis TUS image of thyroid amyloidosis confirmed by cytology Dr Ahmed Esawy
  41. 41. THANK YOU Dr Ahmed Esawy

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