My presentations for Thyroid and its Ultrasound features.

1. Loyal Irene V. Tan

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. 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. 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

6.  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.

7.  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

8.  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.

9.  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.

10.  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.

11.  Longitudinal power Doppler view of the
thyroid (T) shows the normal expected
degree of flow scattered throughout the
gland.

12.  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.

13.  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

14.  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

15.  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)

16.  Entirely solid with no cystic elements.
 Hypoechoic to normal thyroid.
 Microcalcifications ( fine and punctate )
 Associated lymph nodes w/
microcalcifications

17.  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

18.  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

19.  Nodular thyroid disease
 Thyroid lymphoma
 Parenchymal disease

20. - 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

21.  Papillary cancer
 Follicular cancer
 Medullary cancer
 Anaplastic cancer

24.  most common cause of thyroid nodules.
 inspissated colloid is present ( 2 – 3 mms )
 echogenicity is variable (hypoechoic,isoechoic,
hyperechoic)
 frequently have cystic components

25.  Figure 1

26.  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.

27.  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.

28.  Figure 4
 Larger isoechoic nodule (cursors) that is
almost entirely solid but contains a few tiny
cystic spaces.

29.  Figure 5
 Complex nodule (cursors) with cystic and
solid components.

30.  Figure 6
 Cystic nodule (cursors) with thick septations
and low-level intraluminal echoes.

31.  Figure 7
 Cystic nodule (cursors) with thick wall
and a prominent solid mural nodule.

32.  Figure 8
 Simple cyst (cursors) with no detectable wall
but with a large predominantly solid mural
nodule

33.  Figure 9 – Follicular Neoplasm
 Large hyperechoic solid nodule (cursors)
with minimal internal liquefaction.

34.  solid
 echogenicity is hypoechoic to hyperechoic
 Well – marginated border
 Hypoechoic halo is present

35.  Figure 1
 Solid hypoechoic nodule (cursors) with
thin peripheral hyperechoic halo.

36.  Figure 2
 Solid isoechoic nodule (cursors) with
peripheral halo.

37.  Figure 3
 Solid hyperechoic nodule (cursors) with
peripheral halo

38.  Figure 4
 Large solid hyperechoic nodule (cursors) with
scattered internal regions of decreased
echogenicity.

39.  Figure 5
 Solid isoechoic nodule (cursors) with a
peripheral halo and a well-defined internal
cyst.

40.  Figure 6
 Complex cystic and solid nodule
(cursors) that simulates nodular
hyperplasia.

41.  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

42.  Figure 1
 Longitudinal view shows a hypoechoic
homogeneous entirely solid lesion
(cursors).

43.  Figure 2
 Longitudinal view shows a homogeneous
hypoechoic slightly lobulated solid lesion
(cursors).

44.  Figure 3
 Transverse view shows a hypoechoic solid
lesion (cursors) that contains a few
microcalcifications.

45.  Figure 4
 Longitudinal view shows an entirely solid
hypoechoic lesion with scattered
microcalcifications and an irregular halo.

46.  Figure 5
 Longitudinal view shows a solid slightly
heteregeneous nodule (cursors) containing a
few microcalcifications.

47.  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.

48.  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

49.  Figure 1
 Large solid slightly heteregeneous
hypoechoic nodule (cursors).

50.  Figure 2
 Solid hypoechoic nodule (cursors) with a
prominent internal cystic component.

51.  appears as hypoechoic solid mass
 microcalcifications are common in both
primary tumor and nodal metastases
 familial

52.  Longitudinal view shows a solid
hypoechoic nodule (cursors). This
appearance is very similar to that of
papillary cancer.

53.  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

54.  Transverse view shows a large
lobulated solid hypoechoic
mass (cursors) replacing the
entire thyroid.

56. 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

57.  Figure 1
 Transverse extended field-of-view scan
shows a markedly enlarged slightly
heteregeneous hypoechoic thyroid.

58.  Figure 2
 Transverse view shows a solid hypoechoic
mass (cursors) replacing the entire right
lobe and isthmus but sparing the left lobe.

59.  Figure 3
 Longitudinal view near the midline shows
a hypoechoic heterogeneous solid mass
replacing the entire thyroid isthmus.

60.  Longitudinal view shows a simple
anechoic cyst (cursors) with no solid
components.

61.  Longitudinal view shows a nodule with a
thin peripheral rim of calcification that
produces partial shadowing.

62.  Subacute thyroiditis
 Hashimoto’s thyroiditis
 Graves’ disease

63.  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

64.  Fig 1
 Longitudinal view shows an enlarged
thyroid that is diffusedly heteregeneous
and more hypoechoic than normal

65.  Fig 2
 Longitudinal view shows a thyroid that is
hypoechoic and heteregeneous with several
confluent areas of decreased echogenicity

66.  Fig 3
 Longitudinal view shows a thyroid that has
decreased echogenicity and several more
hypoechoic fibrous strands dispersed in
an irregular fashion.

67.  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.

68.  Fig 5
 Longitudinal power Doppler view shows
marked hypervascularity throughout the
thyroid gland.

69.  exopthalmic goiter
 also called diffuse toxic goiter
 gland enlargement
 decreased echogenicity
 Occasional heterogeneity
 hypervascular

70.  Fig 1
 Dual transverse image of the thyroid shows an
enlarged homogeneous but hypoechoic gland
without identifiable nodules.

71.  Fig 2
 Transverse power Doppler view
of the left lobe of the thyroid
shows diffuse hypervascularity
of the gland

72.  also called Quervain’s thyroiditis
 enlarged gland
 poorly marginated area or areas of decreased
echogenicity

73.  Fig 1

74.  Fig 2
 Longitudinal view shows poorly
marginated regions of decreased
echogenicity bilaterally.

75. Godbless!

76. • Ectopia – usually diagnosed with nuclear medicine
scan
• Hypoplasia
• Aplasia
• Thyroglossal duct cysts
– most common of the congenital cysts

77.  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.

78.  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.

79.  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

80.  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

81.  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.