Thyroid lesions – Evaluation with Sonography

Presented BY

DR Laith Al hialy

thyroid disorders – presentation

• thyroid gland enlargement (Goiter )

• Palpable nodule• Hyperthyroidism • Hypothyroidism • Cervical - LN

Imaging Approach for thyroid nodule 2 – institutions ways

• US ( 7-10 MHZ liner – with Doppler study)

• thyroid scintigraphy ( radionuclide 99mTc , 123 Iodine )

• CT , MRI ( none palpable nodule )

• FNA Biopsy

• Palpable Nodule > 1 cm

direct biopsy • Nodule < 1 cm , Cyst also

not appreciated

BY sonographic examination what we can detected ?

• Mass ( nodule Solitary – multiple )

• Cyst • Calcification • Change in thyroid tissue

texture • Cervical LN

Goiter could be presented as retrosternal - upper mediastinal mass

Goiter could compress the trachea

Before after thyroidectomy

Benign lesion

1. Cyst lesion Most common colloid cyst Anechoic , well defined , comet tail appearance

2. Hematoma happen with degenerative nodule

Benign lesion

Nodule ( hyperplasic or adenomatous )

Well defined , smooth margin , texture echogenic –isoechoic , fine hypoechoic rim , curvilinear fine calcification with faint acoustic shadow , equivocal vascularity by Doppler, internal hemorrhage

Benign lesion

Inflammatory condition Hashimoto’s Thyroiditis.

typical sonographic features include: a diffusely enlarged gland demonstrating hypoechoic areas with a very disorganized and heterogeneous pattern

Malignant lesion Papillary carcinoma is the most common thyroid malignancy 75 %

Follicular, Medullary and Aplastic carcinomas and lymphoma make up the remaining 25%

Metastases from lung, breast, and colon cancers

ill defined margin, hypoechoic and

punctuate –micro calcifications

( psammomatous calcification) with acoustic shadow

Hyper vascularity by DopplerThick halo 1-2 mm , cervical LN

Malignant nodule

NHL of thyroid

Thyroid nodule isotopes scan

Hot nodule cold nodule