This document discusses the use of ultrasonography and color Doppler evaluation in the diagnosis of thyroid diseases. It presents the results of a study evaluating 140 patients. Ultrasound was found to have high sensitivity (94.5%) and specificity (85.9%) in differentiating malignant and benign thyroid lesions. Combined ultrasound and color Doppler allowed safe management decisions and guided further diagnostic testing like FNAC. The study concludes that ultrasound and color Doppler should be the primary investigations for evaluating thyroid diseases due to their accuracy and safety compared to other imaging modalities.

1. Dr. Gaurav Kaushik
Resident, Department of Radiodiagnosis
Padmashree Dr. D.Y. Patil Medical college
and Hospital.
ULTRASONOGRAPHY AND COLOR
DOPPLER EVALUATION OF THYROID
DISEASES

2. INTRODUCTION
 The role of high resolution Ultrasonography in
the evaluation of the neck region is becoming
increasingly important due to the availability of
high frequency probes.
 Detection of thyroid lesions by sonography
are common and the incidence is much higher
than the incidence of palpable thyroid
nodules.
 Thyroid sonography is frequently asked to be
performed in the work up of a palpable thyroid
lesion.
 Thyroid lesions are often found unrelated to
palpable neck masses.

3.  Along with being much safer and non-ionising,
ultrasound is also much cheaper alternative to
C.T. and M.R.I. which are used in the evaluation
of thyroid masses, but are not as sensitive as
ultrasound in the detection of intrathyroid
lesions but are used for mediastinal extension
of thyroid masses.
 Thyroid ultrasound differentiates solid from
cystic lesions, solitary from multinodular and
diffuse enlargement, and extrathyroid lesions.
 Nearly 50% of patients with clinically solitary
thyroid nodule have avoided surgery by thyroid
scanning.

4.  The newly developed high resolution
Ultrasonography and color Doppler flow
mapping can reveal fine details of the thyroid
gland and the hemodynamic features of thyroid
neoplasms.
 Thus the combination of conventional
sonography and color Doppler provides benefits
in increasing the screening sensitivity and
improves accuracy in distinguishing different
thyroid abnormalities.
 An attempt was made in present study to
evaluate and establish certain sonographic
criteria for distinguishing benign and malignant
lesions by evaluating a large spectrum of thyroid

5. Aim and Objectives
1. To study spectrum and role of Ultrasound &
Color Doppler in differentiating different
thyroid diseases.
2. To co-relate Ultrasound & Color Doppler with
fine needle aspiration cytology (FNAC)

6. Materials and Methods
 Type of Study: A Prospective Observational
study
 Study Area and Duration: The Study was
conducted in a tertiary care institute and
Medical College of Mumbai for a period of two
years.
 Sampling Technique: Consecutive type of
Non-probability Sampling.
 Sample Size: A total of 140 patients with
thyroid & parathyroid diseases were referred
& USG of thyroid gland was performed.
 Data Analysis: Data was analysed using SPSS

7.  The characteristics studied were the presence
of the nodule, internal characteristic of
lesions, the internal echogenecity of the
nodule, presence of cystic changes, number
of focal lesions,involvement of
gland, calcifications and type of vascularity on
color & power doppler.
 The presence of any significant neck nodes
was also recorded.
 Patients who had suspicious lesions or
change in image characteristic over time or
with equivocal findings were recommended
USG guided FNAC for further definitive
diagnosis.

8. Observations
 USG and color Doppler diagnosis was carried
out on 140 patients . Out of these 120 cases
underwent USG guided FNAC for final
diagnosis (Rest 20 patients were either
directly went for surgery, managed
conservatively or were complimented by other
diagnostic modalities ).
 The age group of the patients ranged from 1-
74 years (mean- 41.2 4.2 years). There
were 46 male and 94 female patients.
 Most patients with thyroid disorders presented
with swelling in front of the neck (64%)
followed by features of hypothyroidism in

9. Main Symptoms Frequency Percent
Asymtomatic 8 5.71%
Constitutional
symptoms 10 7.14%
Difficulty in breathing 4 2.86%
Difficulty in swallowing 8 5.71%
Features of
hyperthyroidism 11 7.86%
Features of
hypothyroidism 28 20.00%
Hoarseness of voice 1 0.71%
Hypercalcemia, raised
PTH 6 4.29%
Swelling in front of neck 64 45.71%
Total 140 100.00%

10. 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
10.71%
32.14%
25.00%
8.57%
3.57%
9.29%
3.57% 3.57% 3.57%
Diagnosis (USG/Doppler)

11. 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
10.00%
27.86%
22.14%
7.86%8.57%7.86%
3.57%3.57%
1.43%0.71%
2.86%3.57%
Final Diagnosis

12. USG & DOPPLER DIAGNOSIS
BENIGN 96 68.5%
MALIGNANT 44 31.5%
Total 140 100%
FINAL DIAGNOSIS
BENIGN 109 77.9%
MALIGNANT 31 22.1%
Total 140 100%

13. STASTISTICAL MEASURE
USG DIAGNOSIS(Malignant
Lesion)
SENSITIVITY 94.50%
SPECIFICITY 85.90%
PPV 67.40%
NPV 98%

14. Conclusion
 The Present study aimed at determining the
accuracy of the combination of USG and Color
Doppler in delineating different thyroid
diseases.
 Amongst them the most important distinction
was between relatively benign lesions vs
suspicious lesions of malignancy.
 The present study shows that combined use of
Ultrasound and Color Doppler as a primary
investigation in symptomatic patients of thyroid
disease allows safe management decisions to
be made and can further direct patient for USG
guided FNAC for reaching a definitive
diagnosis.
 We therefore recommend USG and Color
Doppler to be the first Investigation of choice in

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