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The THYROID Gland
ANATOMY & LOCATION
Brownish-red and soft during life.
Butterfly shaped
Endocrine Gland
Divided into Right & Left lobes, connected by an Isthmus
Located in the neck, medially and anterior to CCA (Common Carotid
Artery) and IJV (Internal Jugular Vein)
Pyramidal lobe (normal variant): Superior extension of the Isthmus
Contains follicles that contain a fluid called “Colloid”
Pyramidal lobe
PHYSIOLOGY
Hypothalamus produces thyroid-releasing hormone
Thyroid-releasing hormone controls the release of
Thyroid-stimulating hormone by the Pituitary gland
Thyroid-stimulating hormone causes Thyroid to
release hormones in its cells.
1. Thyroxine (T4)
2. Triiodothyronine (T3)
3. Calcitonin
PHYSIOLOGY Thyrotropin “Thyroid-stimulating hormone” TSH:
Controlled by Pituitary gland
Produces hormones called:1. Thyroxine (T4): Aids in metabolism of fats, proteins, carbohydrates2. Triiodothyronine (T3): Aids in metabolism of fats, proteins,
carbohydrates3. Calcintonin: Removes calcium in the blood for storage in bones
Uses Iodine, found in vegetables, seafood, and iodized salt to create these hormones
Regulates metabolism so your cells function properly
Affects every cell in the body
Organs affected by Thyroid Hormones:1. Eyes2. Lungs3. Heart4. GI Tract5. Liver6. Uterus7. Skin8. Kidney9. Brain
PATHOLOGY
Goiter: Enlarged Thyroid gland
Hyperthyroidism; Grave’s disease
Hypothyroidism; Hashimoto disease
PATHOLOGY
Goiter - Enlarged, hyperplastic thyroid gland:
An Isthmus that is greater than 10mm indicates an enlarged Thyroid
Thru Ultrasound, an enlarged Thyroid will appear Heterogenous w/
(multiple) cystic and solid components (Adenomatous goiter)
PATHOLOGY
Hyperthyroidism - Overproduction of Thyroid hormones
Signs: Bulging eyes, Heat intolerance, Nervousness, Weight loss, Hair loss
Thru Ultrasound, Thyroid will appear Heterogenous or Hypoechoic with
hypervascularity throughout the gland
Grave’s disease
PATHOLOGYHypothyroidism – Underproduction of Thyroid hormones
Signs: Depression, Sensitive to cold, Elevated blood cholesterol levels, Slight weight gain
Thyroid becomes inflamed, resulting in smaller amounts of thyroid hormones (causing the
Pituitary gland to produce more TSH)
Thru Ultrasound, Thyroid will appear diffusely heterogenous, enlarged, vascular, with
hypoechoic nodules
Hashimoto disease
PATHOLOGYBenign Thyroid Nodules – Common masses, identified with sonography
Considered as Follicular adenomas (most common benign neoplasms) or Hyperplastic
nodules (adenomatous nodules) are multiple and vary in sonographic appearance
Characteristics: Cystic components, less than 5mm, hyperechoic mass, ‘eggshell’
calcifications, ‘hot’ (NM)
PATHOLOGYMalignant Thyroid Nodules – Thyroid cancer
Papillary carcinoma is the most common type of Thyroid cancer
Other types: Follicular carcinoma, Medullary carcinoma, Anaplastic carcinoma,
lymphoma, thyroid metastases
Characteristics: Hypoechoic mass, Mass with calcification, Solitary mass, Enlarged
cervical lymph nodes, irregular margins, internal vascularity of nodule, shape-taller than
wide, ‘cold’ (NM)
PARATHYROID GLANDS, CERVICAL LYMPH NODES, OTHER NECK MASSES Parathyroid Glands – Located on the posterior of each lobe on the middle and inferior poles
1. Serve as calcium regulators, control the release and absorption of calcium by the PTH. 2. Hypocalcemia: Decreased levels of serum calcium3. Hypercalcemia: Elevated levels of serum calcium
Pathology: Parathyroid Adenoma – Elevated Serum calcium and PTHSonographic Appearance - Hypo echoic mass near Thyroid
Cervical Lymph Nodes – Can be found during routine neck sonography1. Usually measure less than 1cm.2. Oblong shaped, hypoechoic with echogenic hilum
Pathology: Cervical Lymphadenopathy - Enlarged cervical lymph nodesSonographic Appearance – Enlarged, greater than 1cm, Round, No echogenic hilum, Calficiations
Other Neck Masses1. Thyroglossal Duct Cyst: Benign congenital cyst. Superior to Thyroid, near Hyoid bone. Palpable
Sonographic Appearance: Anechoic, well-defined, unilocular, with posterior enhancement
2. Brachial Cleft Cyst: Benign congenital cyst. Found near angle of mandible. PalpableSonography Appearance: Anechoic
PARATHYROID GLANDS, CERVICAL LYMPH NODES, OTHER NECK MASSES
MODALITIES: NUCLEAR MEDICINE & SONOGRAPHY Nuclear Medicine - Nuclear medicine specialists use safe, painless, and cost-effective techniques to image the body and treat disease. It provides doctors with information about both structure and function. Nuclear medicine uses very small amounts of radioactive materials (radiopharmaceuticals) to diagnose and treat disease. Uses a 'gamma camera' to detect the radiation from the radioactive material.
Sonography (Ultrasound) - With the use of a transducer that emits high-frequency sound waves to produce relatively precise images of structures within your body.
MODALITIES: NUCLEAR MEDICINE & SONOGRAPHY
ULTRASOUND GUIDED: FINE NEEDLE ASPIRATION A type of biopsy procedure. In fine needle aspiration, a thin needle (attached to a syringe) is
inserted into an area of abnormal-appearing tissue or body fluid. It is then, the contents suctioned out and the specimen are placed on slides and/or containers and sent off to a pathologist for diagnosis.
PAPILLARY CARCINOMA – MEDULLARY CARCINOMA – FOLLICULAR CARCINOMA
ANAPLASTIC CARCINOMA – LYMPHOMA – THYROID METASTASES
REFERENCES
Mosby’s Comprehensive Review for General Sonography
Examinations – Susanna Ovel
Examination Review for Abdomen & Obstetrics and
Gynecology – Steven M. Perry
PATIENT CASES
Take from MDX patient files
PATIENT DEMOGRAPHICS
• 42 yr. old
• Female
• History of Thyroid nodule since 2009
• S/P FNAB 2009
• Latest Ultrasound study May 26,2012
• S/P FNAB March 3,2013
PATIENT DEMOGRAPHICS
• 44 yr. old
• Female
• Thyroid nodules found on the right lobe
• Latest Ultrasound study August 2012
• S/P FNAB November 2012
PATIENT DEMOGRAPHICS
• 82 yr. old
• Female
• Neck mass
• Hx thyroid cancer; papillary carcinoma
• S/P Thyroidectomy 2006 & Radiation therapy
• September 2006; palpable lump on neck Level IV
PATIENT DEMOGRAPHICS
• 39 yr. old
• Female
• Neck mass
• Hx RAI Uptake in right inferior thyroid bed
• S/P thyroidectomy 2010
• Considered for biopsy