anterior neck extending from the level of c5 - t1 overlays 2 nd 4 th tracheal rings anterior neck...
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Anterior neck Extending from the level of C5 - T1 Overlays 2 nd – 4 th tracheal rings Anterior neck Extending from the level of C5 - T1 Overlays 2 nd – 4 th tracheal ringsTRANSCRIPT
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• Anterior neck• Extending from the
level of C5 - T1 • Overlays 2nd – 4th
tracheal rings
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• Average width: 12-15 mm (each lobe)
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• Average height: 50-60 mm long
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1.Thyrotoxicosis.2.Hypothyroidism.3.Thyroid nodules.
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• Hyperthyroidism: A group of symptoms and signs due to increased
production of thyroid hormones by hyper functioning thyroid gland.
• Thyrotoxicosis: A group of symptoms and signs due to elevated
thyroid hormones in the body of any cause.
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• Hyperthyroidism 1- Diffuse toxic goiter (Graves’ disease). 2- Single toxic nodule. 3- Multi-nodular toxic goiter.• Early phase sub-acute thyroiditis.• Exogenous thyroid hormone intake.
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• Radioactive Iodine (RAI) is used for thyroid scan and uptake.
• RAI is given orally.
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• Image and uptake are obtained after 24 hours
• This test determines how much of orally ingested iodine accumulated in the thyroid at 24 hours
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• Symmetric or asymmetric uptake.• Homogeneous or inhomogeneous uptake.• Nodules: Cold or Hot
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• Diffuse enlargement of thyroid gland.• Homogeneous uptake.• No significant focal abnormalities (nodules).• 24-hour RAI uptake is elevated, usually > 35%
(mean of 40%).
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• Single hot nodule (independent of TSH or autonomous).
• Rest of thyroid gland is poorly visualized due to low TSH level (TSH dependent).
• 24-hour RAI uptake is slightly elevated, usually around 20%.
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• Mild inhomogeneous uptake in thyroid gland.
• Multiple cold and hot nodules in both thyroid lobes.
• 24-hour uptake is mildly elevated, usually between 20%-30%.
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• Inhomogeneous uptake could be mild or severe. In some cases thyroid gland is not visualized.
• No significant focal abnormalities (nodules).
• 24-hour RAI uptake is low, usually < 5%.
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• The main cause is chronic thyroiditis (Hashimoto’s thyroiditis).
• TSH is elevated.
• Thyroid scan does not have significant diagnostic value in this entity. Unless, there is nodule, thyroid scan may be helpful.
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Thyroid nodules are common, almost existing in half of the population.
Nodules are usually found by physical examination or by ultrasound.
US is the first modality used to investigate a palpable thyroid nodule.
Scintigraphy is reserved for characterizing functioning nodules and for staging follicular and papillary carcinomas.
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• The patient is usually euthyroid.
• If the patient is hyperthyroid do nuclear scan otherwise do FNA.
• FNA is the most accurate and cost-effective method for diagnostic evaluation of thyroid nodules.
• FNA have a sensitivity of 76%–98%, specificity of 71%–100%
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1. Family history of thyroid cancer.2. History of head and neck irradiation.3. Male Gender.4. Age of less than 30 years or more than 60
years.5. Previous diagnosis of type 2 Multiple
Endocrine Neoplasia
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There is some overlap between the US appearance of benign and malignant nodules.
Certain US features are helpful in differentiating between the two. The malignant features are includes: – Micro-calcifications.– Local invasion.– Lymph node metastases.– A nodule that is taller than it is wider.– Markedly reduced echogenicity.
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Other less specific features of malignant nodules which may be useful, such as: •Absence of a halo.•Ill-defined irregular margins.•Solid composition.•Vascularity,.
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• They are psammoma bodies, which are 10–100-μm round laminar crystalline calcific deposits.
• They are one of the most specific features of thyroid malignancy, with a specificity of 85.8%–95% and a positive predictive value of 24.3%–70.7%
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Figure 2a. Papillary thyroid carcinoma in a 42-year-old man.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Papillary thyroid carcinoma in a 42-year-old man.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Anaplastic thyroid carcinoma in an 84-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Anaplastic thyroid carcinoma in an 84-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Papillary carcinoma and cystic lymph node metastasis in a 28-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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• A completely uniform halo around a nodule is highly suggestive of benignity, with a specificity of 95%
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Follicular adenoma in a 30-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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• Papillary thyroid carcinomas had some intrinsic blood flow
• Avascular nodule is very unlikely to be malignant.
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Renal cell carcinoma metastases to the thyroid in a 69-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Renal cell carcinoma metastases to the thyroid in a 69-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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Follicular adenoma in a 36-year-old woman.
Hoang J K et al. Radiographics 2007;27:847-860
©2007 by Radiological Society of North America
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• Marked hypoechogenicity is very suggestive of malignancy.
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B cell lymphoma of the thyroid in a 73-year-old woman with Hashimoto thyroiditis.
Hoang J K et al. Radiographics 2007;27:847-860
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• The size of a nodule is not helpful for predicting or excluding malignancy.
• There is a common but mistaken practice of
selecting the largest nodule in a multinodular thyroid for FNA.
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• Although most patients with nodular hyperplasia have multiple thyroid nodules and some patients with thyroid carcinoma have solitary nodules, the presence of multiple nodules should never be dismissed as a sign of benignity.
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• In general, interval growth of a thyroid nodule is a poor indicator of malignancy. Benign thyroid nodules may change in size and appearance over time.
• The exception is clinically detectable rapid interval growth, which most commonly occurs in anaplastic thyroid carcinoma but also may occur in lymphoma, sarcoma, and, occasionally, high-grade carcinoma.
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Society of Radiologists in Ultrasound Consensus Conference Statement
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US images of thyroid nodules of varying parenchymal composition (solid to cystic).
Proved to be benign at cytologic examinationFrates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America
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US images of thyroid nodules of varying parenchymal composition (solid to cystic).
Proved to be benign at cytologic examinationFrates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America
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Predominantly solid thyroid nodule.
Papillary carcinomaFrates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America
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The lesion was benign at cytologic examination Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America
Predominantly cystic nodule with small solid-appearing mural component
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• Rounded bulging shape.• Increased size.• Replaced fatty hilum .• Irregular margins.• Heterogeneous echotexture.• Calcifications.• Cystic areas.• Vascularity throughout the lymph node instead
of normal central hilar vessels at Doppler imaging.
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Abnormal cervical lymph nodes.
Metastatic papillary carcinomaFrates M C et al. Radiology 2005;237:794-800
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Abnormal cervical lymph nodes.
Mtastatic papillary carcinoma.Frates M C et al. Radiology 2005;237:794-800
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• The needle may be introduced parallel or perpendicular to the transducer, and the needle tip should be carefully monitored during the procedure.
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Figure 7a. Parallel positioning of the fine-gauge needle for thyroid nodule biopsy.
Kim M J et al. Radiographics 2008;28:1869-1886
©2008 by Radiological Society of North America
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Parallel positioning of the fine-gauge needle for thyroid nodule biopsy.
Kim M J et al. Radiographics 2008;28:1869-1886
©2008 by Radiological Society of North America
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Figure 8a. Perpendicular positioning of the fine-gauge needle for thyroid nodule biopsy.
Kim M J et al. Radiographics 2008;28:1869-1886
©2008 by Radiological Society of North America
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Clinical history:Slow onset (months), painless exophthalmos.
Patterns of muscle involvement in thyroid opthalmopathy:
1. Bilateral (85%)2. Unilateral (5%)3. Normal muscles (10%)
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• Patients need not be hyperthyroid (some are euthyroid).
• Coronal imaging is the method of choice for assessing muscle thickness
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• Seen in setting of chronic, end-stage renal disease.
• Related to combination of secondary hyperparathyroidism + osteomalacia.
• Osteopenia is most common finding; however, 10-20% of patients also exhibit osteosclerosis.
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• Characteristic finding of osteosclerosis is "Rugger jersey spine"
Bands of hazy sclerosis that parallels the vertebral body endplates
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• Additional signs of hyperparathyroidism such as:
1. Resorption of secondary trabeculae.2.Cortical thinning. 3.Subperiosteal bone resorption.4. Brown tumors are often present. • Both axial and appendicular skeleton involved. • Increased risk for pathologic fracture.
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