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Thyroid cancer
Ultrasound findings
most common thyroid cancer types
papillary – young, most common type
follicular
anaplastic – old
medullary – MEN2
US is the first-line imaging modality
to look at the thyroid
suspicious US findings in thyroid nodules
intensely hypoechoic nodule, more so than muscle
irregular contours: angulated, lobulated, spiculated
don’t mistake irregular for ill-defined or flou
microCa++
small echogenic particles w/o acoustic shadowing
high specificity for malignancy
always look for microCa++ with thyroid nodule
taller than wide
stiff nodule at elastography
malignant cervical lympadenopathy
US of lymph nodes mandatory if thyroid nodule detected
presence of just 1 suspicious findings
 high suspicion of malignancy – TIRADS 4B
other findings
thick irregular hypoechoic halo
anarchic vascularization
*papillary, follicular, medullary thyroid cancer types
 all share similar US aspect
Anaplastic thyroid cancer
old population
very poor prognosis
risk factors: radiation, goitre
Anaplastic thyroid cancer
large mass
locally invasive
heterogeneous – Ca++, necrosis, hemorrhage
irregular
malignant lymph nodes
US can not distinguish between adenoma
and low-grade malignant nodules
US can not tell between adenoma and low-grade malignant nodules
lab work helps
if hyperthyroidism, low risk of malignancy
nuclear scan helps
if “hot”, low risk of malignancy
 combined findings may allow to forego FNAB
Remember
presence of just 1 of the 6 suspicious findings is sufficient
to call nodule highly suspicious of malignancy
always look for microCa++ within thyroid nodule
always assess cervical lymph nodes with thyroid nodule

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Thyroid cancer - ultrasound findings

  • 2. most common thyroid cancer types papillary – young, most common type follicular anaplastic – old medullary – MEN2
  • 3. US is the first-line imaging modality to look at the thyroid
  • 4. suspicious US findings in thyroid nodules intensely hypoechoic nodule, more so than muscle irregular contours: angulated, lobulated, spiculated don’t mistake irregular for ill-defined or flou microCa++ small echogenic particles w/o acoustic shadowing high specificity for malignancy always look for microCa++ with thyroid nodule taller than wide stiff nodule at elastography malignant cervical lympadenopathy US of lymph nodes mandatory if thyroid nodule detected
  • 5. presence of just 1 suspicious findings  high suspicion of malignancy – TIRADS 4B
  • 6. other findings thick irregular hypoechoic halo anarchic vascularization *papillary, follicular, medullary thyroid cancer types  all share similar US aspect
  • 7. Anaplastic thyroid cancer old population very poor prognosis risk factors: radiation, goitre
  • 8. Anaplastic thyroid cancer large mass locally invasive heterogeneous – Ca++, necrosis, hemorrhage irregular malignant lymph nodes
  • 9. US can not distinguish between adenoma and low-grade malignant nodules
  • 10. US can not tell between adenoma and low-grade malignant nodules lab work helps if hyperthyroidism, low risk of malignancy nuclear scan helps if “hot”, low risk of malignancy  combined findings may allow to forego FNAB
  • 11. Remember presence of just 1 of the 6 suspicious findings is sufficient to call nodule highly suspicious of malignancy always look for microCa++ within thyroid nodule always assess cervical lymph nodes with thyroid nodule