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Thyroid

My presentations for Thyroid and its Ultrasound features.

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Thyroid

  1. 1. Loyal Irene V. Tan
  2. 2.  High frequency transducers ( 7.5 – 15.0 MHz )  Linear array transducers  Doppler examination provided  Examine in supine position with the neck extended  Examine in both transverse and longitudinal plane
  3. 3. Thyroid - located in the anterior inferior neck, lateral lobes lying on either side of the trachea - the thyroid is an endocrine gland that secretes three major hormones: thyroxine, triidothyronine and calcitonin  Hyperechoic to adjacent muscles  Homogeneous  Scattered readily detectable internal vessels  Lobes less than 2 cm anteroposterior (ap) and transverse Isthmus less than 4 mm
  4. 4. Adult: Lobes Length : 4 to 6 cm Width : 1.5 to 2 cm ( AP diameter ) Height : 2 to 3 cm Isthmus: less than 4 mm Newborn: Length:18 to 20 mms AP : 12 to 15 mms 1 year : Length: 25 mms AP : 13 to 18 mms
  5. 5.  Transverse extended-field-of-view scan of the neck shows the normal right and left lobes of the thyroid (T) located on either side of the Shadowing produced by the trachea (Tr).  The common carotid arteries (C) and the right internal jugular vein (V) are seen lateral to the thyroid.  The overlying strap muscles (S) are located immediately anterior to the thyroid and the sternocleidomastoid muscles (Sc) are seen anterolateral to the thyroid.
  6. 6.  Transverse extended-field-of-view scan shows the right lobe of the thyroid has enlarged and extended anterior to the common carotid artery (C).  The jugular vein (V) and the trachea (Tr) are also seen
  7. 7.  Conventional transverse scan view of the right thyroid lobe shows the thyroid (T) and the trachea (Tr).  The isthmus (I) of the thyroid is seen anterior to the trachea.  The strap muscles (S) and sternocleidomastoid (Sc) are also seen anteriorly and laterally.  The longus colli muscle (Lc) is seen posteriorly.  The carotid (C) and jugular vein (V) are seen lateral to the thyroid.
  8. 8.  Conventional transverse view of the left thyroid lobe shows the same structures as on the right.  In addition, the left lateral edge of the esophagus (E) is seen posterior to the trachea. The typical bowel layers are seen in the esophagus.
  9. 9.  Longitudinal view of the thyroid (T) shows the lenticular shape of the thyroid and the hyperechoic echogenicity of the thyroid compared with the overlying strap muscles (S) and the sternocleidomastoid (Sc).  The longus colli (Lc) is seen posteriorly.
  10. 10.  Longitudinal power Doppler view of the thyroid (T) shows the normal expected degree of flow scattered throughout the gland.
  11. 11.  Transverse view of the thyroid shows a normal right lobe (R) and a normal isthmus (I).  No identifiable left lobe is present.  The trachea (T) is seen laterally.
  12. 12.  A palpable mass  Diffuse enlargement on physical examination  A non palpable mass seen on other imaging modality ( MRI and C.T scan )  Nodule seen on nuclear medicine scan  Abnormal thyroid function test
  13. 13.  Detection of thyroid and other cervical masses before and after thyroidectomy  Differentiation of benign from malignant masses on the basis of their sonographic appearance  FNA (biopsy) guidance
  14. 14.  Simple cysts.  Echogenicity ( Hyper or isoechoic to normal thyroid )  Calcifications - peripheral eggshell ( most reliable feature ) - large and coarse - > 2 mms  Inspissated colloid ( bright foci with comet tail artifact)
  15. 15.  Entirely solid with no cystic elements.  Hypoechoic to normal thyroid.  Microcalcifications ( fine and punctate )  Associated lymph nodes w/ microcalcifications
  16. 16.  Peripheral hypoechoic halo - benign - thin and regular *** found also with follicular cancers - malignant - thick and irregular  Margin - benign - sharp well-defined margins - malignant - irregular or poorly defined margins  Multiplicity of nodules - benign - multiple - malignant - solitary nodule *** papillary cancer is multifocal and it is uncommon for thyroid cancer to coexist with nodular hyperplasia  Doppler flow pattern - benign - peripheral vascularity - malignant - internal vascularity (hyper) with or w/o peripheral component *** high sensitivity doppler instruments may significantly increase the confusion
  17. 17.  Nodule size - > 1.5 cms irrespective of physical and sonographic features  Nodule that have malignant features  Most effective method for diagnosing malignancy in thyroid nodule  Has had a substantial impact because it provides more direct information than any other available diagnostic technique
  18. 18.  Nodular thyroid disease  Thyroid lymphoma  Parenchymal disease
  19. 19. - extremely common and are the most common indication for thyroid ultrasound  Nodular hyperplasia  Benign follicular adenomas  Follicular adenomas and follicular cancer - same sonographic appearance - distinguished only on the basis of vascular and capsular invasion - therefore FNA of follicular aspiration should generally followed by surgical resection
  20. 20.  Papillary cancer  Follicular cancer  Medullary cancer  Anaplastic cancer
  21. 21.  most common cause of thyroid nodules.  inspissated colloid is present ( 2 – 3 mms )  echogenicity is variable (hypoechoic,isoechoic, hyperechoic)  frequently have cystic components
  22. 22.  Figure 1
  23. 23.  Figure 2  Fig 1 and 2 shows hypoechoic nodules ( cursors ) that are predominantly solid with multiple small internal cystic spaces.  This is the typical appearance for small lesions.
  24. 24.  Figure 3  Nodule Similar to those in Fig 1 and 2 with additional finding of inspissated colloid (arrow), which cast a short comet tail artifact.
  25. 25.  Figure 4  Larger isoechoic nodule (cursors) that is almost entirely solid but contains a few tiny cystic spaces.
  26. 26.  Figure 5  Complex nodule (cursors) with cystic and solid components.
  27. 27.  Figure 6  Cystic nodule (cursors) with thick septations and low-level intraluminal echoes.
  28. 28.  Figure 7  Cystic nodule (cursors) with thick wall and a prominent solid mural nodule.
  29. 29.  Figure 8  Simple cyst (cursors) with no detectable wall but with a large predominantly solid mural nodule
  30. 30.  Figure 9 – Follicular Neoplasm  Large hyperechoic solid nodule (cursors) with minimal internal liquefaction.
  31. 31.  solid  echogenicity is hypoechoic to hyperechoic  Well – marginated border  Hypoechoic halo is present
  32. 32.  Figure 1  Solid hypoechoic nodule (cursors) with thin peripheral hyperechoic halo.
  33. 33.  Figure 2  Solid isoechoic nodule (cursors) with peripheral halo.
  34. 34.  Figure 3  Solid hyperechoic nodule (cursors) with peripheral halo
  35. 35.  Figure 4  Large solid hyperechoic nodule (cursors) with scattered internal regions of decreased echogenicity.
  36. 36.  Figure 5  Solid isoechoic nodule (cursors) with a peripheral halo and a well-defined internal cyst.
  37. 37.  Figure 6  Complex cystic and solid nodule (cursors) that simulates nodular hyperplasia.
  38. 38.  much more common than other types  solid hypoechoic mass or tumor  tiny microcalcifications noted  hypervascularity  cervical lymph node metastases are common and may contain microcalcifications  spread via lymphatics to nearby cervical lymph nodes
  39. 39.  Figure 1  Longitudinal view shows a hypoechoic homogeneous entirely solid lesion (cursors).
  40. 40.  Figure 2  Longitudinal view shows a homogeneous hypoechoic slightly lobulated solid lesion (cursors).
  41. 41.  Figure 3  Transverse view shows a hypoechoic solid lesion (cursors) that contains a few microcalcifications.
  42. 42.  Figure 4  Longitudinal view shows an entirely solid hypoechoic lesion with scattered microcalcifications and an irregular halo.
  43. 43.  Figure 5  Longitudinal view shows a solid slightly heteregeneous nodule (cursors) containing a few microcalcifications.
  44. 44.  Figure 6  Longitudinal view shows a large complex lesion (cursors) that is a solid but contains large internal cystic components.  This is a follicular variant of papillary carcinoma.
  45. 45.  thick, irregular halo  tortuous or chaotic arrangement of internal vessels on color doppler  frequently coexists with multinodular goiters  no microcalcifications and nodal metastases seen  spread via bloodstream
  46. 46.  Figure 1  Large solid slightly heteregeneous hypoechoic nodule (cursors).
  47. 47.  Figure 2  Solid hypoechoic nodule (cursors) with a prominent internal cystic component.
  48. 48.  appears as hypoechoic solid mass  microcalcifications are common in both primary tumor and nodal metastases  familial
  49. 49.  Longitudinal view shows a solid hypoechoic nodule (cursors). This appearance is very similar to that of papillary cancer.
  50. 50.  appears as a large, solid, hypoechoic mass extending beyond the gland and invading adjacent structures such as the neck vessels and neck muscles  not adequately examined by US because of their large size  Instead CT or MRI scan of the neck demonstrates more accurately the extent of the disease  rarely seen in patients younger than 60 years old
  51. 51.  Transverse view shows a large lobulated solid hypoechoic mass (cursors) replacing the entire thyroid.
  52. 52. Thyroid lymphoma - occur as either a manifestation of generalize lymphoma or as a primary abnormality - usually large, solid, hypoechoic mass that infiltrates much of the thyroid parenchyma
  53. 53.  Figure 1  Transverse extended field-of-view scan shows a markedly enlarged slightly heteregeneous hypoechoic thyroid.
  54. 54.  Figure 2  Transverse view shows a solid hypoechoic mass (cursors) replacing the entire right lobe and isthmus but sparing the left lobe.
  55. 55.  Figure 3  Longitudinal view near the midline shows a hypoechoic heterogeneous solid mass replacing the entire thyroid isthmus.
  56. 56.  Longitudinal view shows a simple anechoic cyst (cursors) with no solid components.
  57. 57.  Longitudinal view shows a nodule with a thin peripheral rim of calcification that produces partial shadowing.
  58. 58.  Subacute thyroiditis  Hashimoto’s thyroiditis  Graves’ disease
  59. 59.  diffuse infiltration  gland is normal or enlarged with hypoechoic,coarse and heteregeneous echotexture  extremely hypervascular  common cause of hypothyroidism  also called chronic autoimmune lymphocytic thyroiditis  heteregeneous texture-thin echogenic fibrous strands present causing to have a multilobulated or micronodular appearance
  60. 60.  Fig 1  Longitudinal view shows an enlarged thyroid that is diffusedly heteregeneous and more hypoechoic than normal
  61. 61.  Fig 2  Longitudinal view shows a thyroid that is hypoechoic and heteregeneous with several confluent areas of decreased echogenicity
  62. 62.  Fig 3  Longitudinal view shows a thyroid that has decreased echogenicity and several more hypoechoic fibrous strands dispersed in an irregular fashion.
  63. 63.  Fig 4  Transverse view of the thyroid shows diffuse heterogenecity and decreased echogenicity with two discrete hyperechoic nodules (cursors).  Fine-needle aspiration confirmed that these nodules were also due to Hashimoto’s thyroiditis.
  64. 64.  Fig 5  Longitudinal power Doppler view shows marked hypervascularity throughout the thyroid gland.
  65. 65.  exopthalmic goiter  also called diffuse toxic goiter  gland enlargement  decreased echogenicity  Occasional heterogeneity  hypervascular
  66. 66.  Fig 1  Dual transverse image of the thyroid shows an enlarged homogeneous but hypoechoic gland without identifiable nodules.
  67. 67.  Fig 2  Transverse power Doppler view of the left lobe of the thyroid shows diffuse hypervascularity of the gland
  68. 68.  also called Quervain’s thyroiditis  enlarged gland  poorly marginated area or areas of decreased echogenicity
  69. 69.  Fig 1
  70. 70.  Fig 2  Longitudinal view shows poorly marginated regions of decreased echogenicity bilaterally.
  71. 71. Godbless!
  72. 72. • Ectopia – usually diagnosed with nuclear medicine scan • Hypoplasia • Aplasia • Thyroglossal duct cysts – most common of the congenital cysts
  73. 73.  Appear as cystic lesions with low-level intraluminal reflectors, presumably due to bleeding or infection.  Usually do not appear as simple cysts.  Most common of the congenital cysts in the neck.  Located in the midline between the thyroid gland and the hyoid bone.
  74. 74.  Figure 1  Longitudinal view of the midline of the neck in the suprathyroidal region shows the hyoid bone (H) and the thyroid cartilage (T) their associated shadows.  A complex cystic lesion (cursors) with diffuse low- level echoes is seen located immediately between these two structures.  This is the typical location for a thyroglossal duct cyst.
  75. 75.  Figure 2  Transverse view of the midline neck in the suprathyroidal region shows a complex cystic lesion (cursors) with low-level echoes and a thin septation
  76. 76.  Figure 3  Transverse view of the neck above the level of the thyroid gland shows the thyroid cartilage (arrowheads), extending from the midline over the left is a complex cystic lesion (cursors) consistent with a thyroglossal cyst
  77. 77.  Longitudinal view of the right lobe of the thyroid shows a slightly lobulated solid predominantly hypoechoic nodule (cursors)  This patient had a history of melanoma and fine-needle aspiration confirmed metastatic melanoma to the thyroid.

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