Presentazione etiopia

ULTRASONOGRAPHY AND THYROID DISEASE Massimiliano Andrioli San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan University of Milan

ULTRASOUND PRINCIPLES ,[object Object],[object Object],Ultrasound diffusion from multiple point sources Cell/colloid interface with different acustic impedance Ecographic rapresntation of reflexed echoes

PHYSICAL ULTRASOUND PRINCIPLES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Color-Doppler. Flow towards the probe (red) and from the probe (blu) Power-Doppler. Slow flow in small vessels

ECOGRAPHIC THYROID ANATOMY SCM sternocleidomastoideus OI omohyoid SI sternohyoid ST sternothyroid E esophagus C carotid G jugular T trachea ATI inferior thyroid artery MLC longus colli muscle L thyroid lobe I isthmus

L thyroid lobe MLC longus colli muscle ECOGRAPHIC THYROID ANATOMY

ECOGRAPHIC LYMPH NODES ANATOMY I level: submental/submandibular II level: superior jugular, jugulodigastric, anterior spinal III level: mid jugular IV level: inferior jugular V level: spinal accessory VI level: central compartment (prelaryngeal, pretracheal, ricorrential, anterior-superior mediastinal) VII level: mediastinal ,[object Object],[object Object],[object Object]

NORMAL THYROID ,[object Object],[object Object],[object Object]

THYROID VOLUME ,[object Object],[object Object],[object Object],Modifed from Vitti et al. 1994 Deficient area Sufficient area

AUTOIMMUNE DISEASES ,[object Object],Thyroiditis histology: widely lymphocitic infiltration Reduction of cell/colloid interfaces. A lower number of echoes are reflexed and the gland appears hypoechoic. ,[object Object]

HASHIMOTO’S THYROIDITIS ,[object Object],[object Object],[object Object],[object Object],[object Object],Hypoechogenicity and hypothyroidism at first evaluation Hypoechogenicity and hypothyroidism development in the following 3 years Echogenicity and autoatibodies levels

[object Object],HASHIMOTO’S THYROIDITIS

GRAVES’ DISEASE ,[object Object],[object Object],[object Object],Relapse of hyperthyroidism after therapy and hypoechogenicity Relapse of hyperthyroidism after therapy, TRAb and hypoechogenicity

[object Object],[object Object],GRAVES’ DISEASE AFTER METHIMAZOLE AFTER METHIMAZOLE

ULTRASONOGRAPHIC DIFFERENTIAL DIAGNOSIS ,[object Object],[object Object],? ? GRAVES HASHIMOTO HASHIMOTO GRAVES

SUBACUTE THYROIDITIS ,[object Object],[object Object],[object Object],AFTER STEROID

NODULAR DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Features of suspect malignancy: hypoechogenicity, irregular margins, intralesional vascularization, microcalcifications, intra-lesional vascularizzation (type III) NODULAR DISEASE

[object Object],[object Object],[object Object],[object Object],[object Object],ELASTOGRAPHY

[object Object],[object Object],[object Object],[object Object],ELASTOGRAPHY

4 ELASTICTY PATTERNS ES 1 nodules presenting elasticity in the whole examined area (the nodule is homogeneously green) ES 2 nodules displaying elasticity in a large portion of the examined area (the nodule is green with someperipheral and/or central blue areas); ES 3 was assigned to nodules with stiffness in a large portion of the examined area (the nodule is blue with some peripheral and/or central green areas); ES 4 was assigned to anelastic nodules (the whole nodule is homogenously blue) ELASTOGRAPHY

ULTRASOUND GUIDED FINE NEEDLE CITOLOGY (FNC) ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ROLE OF ULTRASOUND IN THYROID DISEASE

INDICATIONS FOR ULTRASONOGRAPHY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Thank you for your attention… www.endocrinologiaoggi.it

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