THYROID

THYROID GLAND
GLAND

DR.SHAMIM
DR.SHAMIM RIMA
RIMA
MBBS,DMU,FCGP
MBBS,DMU,FCGP
M.PHIL
M.PHIL
RADIOLOGY
RADIOLOGY && IMAGING
IMAGING
 INSTRUMENTATION AND TECHNIQUE
 High-frequency transducers (7.5-15.0 MHz).
 Linear-array transducers are preferred to sector transducers.
 The pt is typically examined in the supine position, with the neck
extended.
 A small pad may be placed under the shoulders to provide better
exposure of the neck.
 Examined thoroughly in transverse and longitudinal planes.
 Imaging of the lower poles can be enhanced by asking the patient
to swallow, which raise the gland in the neck.
 The entire gland, including the isthmus, must be examined.
 The examination extended laterally to include the region of the
carotid artery and jugular vein in order to identify enlarged jugular
chain lymph nodes,
 Superiorly to visualize submandibular adenopathy,
 Inferiorly to define any pathologic supraclavicular lymph nodes.
SITE OF THYROID ULTRASOUND 
 ANATOMY
 Components
-Two Lateral lobes
-Isthmus centrally connects
the lobes
 Size :
 In new born:
length : 18-20mm
AP diameter: 8-9mm
 One year:
length : 25mm
AP diameter: 12-15mm
 Adult:
length: 40-60mm
AP diameter: 13-18mm.
 Isthmus : 4-6mm.
 NORMAL THYROID USG

 Normal thyroid parenchyma has a homogeneous

medium to high-level echogenicity .
 CONGENITAL THYROID ABNORMALITIES

 Agenesis :
One lobe or whole gland.

 Hypoplasia
 Ectopia
 USG findings:

Diminutively sized gland.

THYROID AGENESIS
AGENESIS
CONGENITAL ABSENCE OF THE ENTIRE THYROID
HEMIAGENESIS OF THE THYROID
Thyroid isthmus agenesis with solitary nodule
 ECTOPIC THYROID

An ectopic thyroid can occur anywhere along the course followed

by thyroglossal duct during its embryonic descent from the tongue
—resulting in a
lingual, suprahyoid, subhyoid, or even an intratracheal thyroid.
1 A thyroglossal duct cyst is commonly associated with the clinical
ectopic thyroid. Since ectopic thyroid tissue always raises the
possibility of metastatic thyroid cancer, it is pivotal to identify the
possible malignancy when an ectopic thyroid or thyroglossal duct
cyst is noted.
2 However, the absence of a normal thyroid gland may occur in
the patients with clinically evident ectopic thyroid. 
THYROID PAPILLARY CARCINOMA IN SUBHYOID ECTOPIC THYROID TISSUE

Thyroid ultrasonography of ectopic thyroid showed ahypoechoic,

heterogenous nodule with perinodular vascularisation
HYPOPLASIA OF THYROID GLAND
 NODULAR THYROID DISEASE

 HYPERPLASIA AND GOITER:

- 80% of nodular thyroid disease is due to hyperplasia

of the gland.
 GOITER:
- Hyperplasia leads to an overall increase in size or
volume of the gland.
- Peak age : between 35 & 50 years.
- females are three times more than males.
 Cont;
 Hyperplastic nodules often undergo liquefactive
degeneration with the accumulation of blood, serous fluid
and colloid substance, refffered to as hyperplastic,
adenomatous, or colloid nodules.
 Coarse and perinodular calcification occur.

SONOGRAPHICALLY:
 most hyper plastic or adenomatous nodules are isoechoic
compared to normal thyroid tissue.
 Size of the mass increases, it may become hyperechoic.
 Less frequently hypo echoic sponge-like pattern is seen.
 Cont’
 When the nodule is isoechoic or hypoechoic, a thin peripheral
hypoechoic halo is seen.
 Degenerative changes of goitrous nodules correspond to their
sonographic appearance;

- Purely anechoic – due to serous or colloid fluid.

- Echogenic fluid or moving fluid-fluid levels correspond to-

Hemorrhage

- Bright echogenic foci with comet-tail artifacts are likely to be due

to presence of dense colloid material.

- Intracystic thin septaions probably correspond to attenuated

strand of thyroid tissue.
MULTINODULAR GOITER
Multinodular goiter:
COLLOID NODULE
 Multinodular goiter:

 A huge complex mass (8 x

6 cms.) containing both
cystic and solid areas, in
the right lobe of the
enlarged thyroid.
 Relatively spared left lobe
which shows normal size,

but has fine nodularity.

 Hemorrhagic colloid cyst of the thyroid

 The above sonographic images of the right lobe of thyroid show a large
cyst measuring 1.8 x 1.5 cms. The walls appear irregular with fine debris
within the lumen of the thyroid cyst. Color doppler image (on right) shows
normal vascularity with no vessels within the cyst. These ultrasound
images suggest Hemorrhagic colloid cyst of the thyroid.
 Malignant thyroid nodule:

 Sonography of the thyroid, revealing a markedly hypoechoic nodule of 1.1

cms. width, in the left half of the isthmus of the thyroid. The lesion also
shows echogenic specks microcalcification and an irregular border. Also
note that the nodule is as tall as it is wide. All these ultrasound findings
favor a diagnosis of malignancy on this thyroid nodule
MALIGNANT NODULE
 ADENOMA
 Represent 5%-10% all nodular disease of thyroid.
 Seven times more common in female than male.
 Most are solitary, may be multinodular.
 SONOGRAPHICALLY:
 Usually solid masses.
 May be hyper echoic, iso echoic or hypo echoic.
 Often have a peripheral hypoechoic halo,thick and smooth.
 Color Doppler: vessels pass from the periphery to the central
regions of the nodule, creating a” spoke–and-wheel-like “
appearance.
 CARCINOMA
 Papillary cancer :
 Prevalent in young adult pt.
 Female
 Nonencapsulated sclerosing tumour measuring 1cm or less
in diameter.
 80% of cases – enlarged cervical nodes

- palpable normal thyroid gland.

SONOGRAPHIC CHARACTERISTICS:
 Hypoechogenicity – 90% of cases.
 Microcalcifications appear as tiny, punctate hyperechoic
foci,with or without acoustic shadows,
 Cont’

 Hypervascularity with disorganized vascularity, mostly in

well-encapsulated forms.
 Cervical lymph node metastasis which may contain
tiny,punctate echogenic foci due to microcalcifications.
Metastaticnode may be cystic.
 TYPICAL APPEARANCE OF PAPILLARY CARCINOMA:
 Solid hypoechoic mass.
 Tiny echogenic foci due to microcalcifications.
 Hypervascularity on color Doppler.
 Cervical lymph node metastasis.
PAPILLARY THYROID CARCINOMA
Sonography of a 35-year-old female with papillary carcinoma. 
Sonography shows a hypoechoic thyroid nodule with fine
calcifications and an irregular margin. This nodule demonstrates no
cystic change and no surrounding hypoechoic rim
 FOLLICULAR THYROID CARCINOMA

 5-15%.
 Female >male.
 Type:

- minimally invasive :

encapsulated,

focal invasion of capsular blood vessels of the

fibrous capsule itself.

- widely invasive :

not well encapsulated,

invade blood vessels and adjacent thyroid.

 Cont’
 Metastasis: via blood stream

- bone,

- lung

- brain

- liver.
 SONOGRAPHIC FEATURES:

- Irregular tumor margin

- thick irregular halo

- tortuous or chaotic arrangement of internal blood vessels.

 Sonography of a 54-year-old female with follicular carcinoma. 
There is an isoechoic thyroid nodule with heterogeneous
echogenicity. This nodule shows flat orientation and a smooth,
thick hypoechoic rim without internal calcifications or any cystic
changes.
Coarse calcification in an invasive follicular carcinoma
 MEDULLARY CARCINOMA
 5 %.
 Derived from parafollicular cells, or C cells.
 Secrets hormone calcitonin.
 Familial 20 %.
 Essential component of multiple endocrine neoplasia (MEN) type II
syndrome.
 Multicentric or bilateral in 90 % case.
 Local invasion & metastasis to cervical nodes is more.
 Bright, punctate,echogenic foci caused by nests of amyloid or calcification
are detectable in 80 % to 90 %.
 USG APPEARANCE :

- solid hypoechoic mass,

- Bright, punctate,echogenic foci

- Hypervascularity on color doppler.

Medullary Thyroid Carcinoma Associated With Hyperthyroidism: 
A medullary thyroid carcinoma demonstrating a poorly defined irregular margin
 ANAPLASTIC THYROID CARCINOMA

 Elderly.
 Most lethal solid tumor.
 > 5 %.
 Rapidly enlarging mass extending beyond the gland & invading
adjacent structures.
 Often associated with papillary or follicular carcinoma.
 Not spread via lymphatics.
 Prone to aggressive local invasion of muscles & vessels.
 SONOGRAPHIC FEATURES:

- Hypoechoic masses.

- encase or invade blood vessels

- Invade neck muscle.

 LYMPHOMA
 4 %.
 Non-Hodgkin’s type.
 Affect older female.
 C/C, rapidly growing mass causes symptoms of dyspnea &
dysphagia.
 70 %- 80% arises from preexisting chronic lymphocytic thyroiditis
with sub clinical or overt hypothyroidism.
 SONOGRAPHICALLY :
 Hypoechoic,lobulated mass nearly avascular.
 Large areas of cystic necrosis
 Encasement of adjacent neck vessels.
 Adjacent thyroid parenchyma may be heterogeneous due to
chronic thyroiditis.
A hypoechoic mass replacing the right lobe of the gland with early
extracapsular spread(arrow). These appearances are non-specific and may be
seen in anaplastic carcinoma and primary thyroid lymphoma.
 DIFFUSE THYROID DISEASE

 Generalized of thyroid gland and no palpable nodules.

 Isthmus upto 1cm or more.
 Conditions:

- acute supporative thyroiditis

- subacute granulomatous thyroiditis

- hashimoto’s (chr.lymphocytic) thyroiditis

- adenomatous or colloid goiter

- painless (silent) thyroiditis.

- Graves disease

- Invasive fibrous thyroiditis.

 HASHIMOTO'S THYROIDITIS

 1) hypoechoic thyroid
gland
 2) coarse echotexture of
the gland
 3) fine linear echoes
within the thyroid
parenchyma s/o fibrosis
4) Color doppler imaging
reveals augmentation of
the vascularity of the
thyroid gland.
 SUB-ACUTE GRANULOMATOUS THYROIDITIS

 appear enlarged &

hypoechoic with
normal or decsreased
vascularity
 Chronic thyroiditis. Ultrasound image.

 Diffuse enlargement of gland.

 Homogeneous with coarse parenchymal echotexture
 More hypoehoic than normal gland.
 Multiple discrit hypoechoic nodules seen.
 Pseudolobulated appearance of parenchyma.