Thyroid Ultrasonography: clinical and radiological correlations Dr.M.Thijs Radiology
Anatomy Inflammatory Thyroid Disease Benign lesions Thyroid tumors Thyroglossal duct cyst
Anatomy Transverse Longitudinal
Anatomy
Inflammatory Thyroid Disease
Autoimmune thyroiditis Hashimoto s thyroiditis Graves disease
34 yr: Hashimoto s thyroidits, hypothyroid fase
Hashimoto s thyroiditis
33 yr: Postpartum, hypothyroid
Hashimoto s thyroiditis: endstage 58 yr
Graves disease: 32 yr
Graves disease Thyroid inferno Ralls et al. (1988)
Relapse Graves postpartum
Relapse Graves postpartum
Graves disease, 45 yr
Subacute granulomatous thyroiditis. De Quervain thyroiditis. Clinical presentations vary between focal and diffuse disease
46 yr: Since 1 month painful thyroid Areas of painful induration
Granulomatous thyroiditis.
41 yr 18.10.2005 18.11.2005
21.02.2006: right lobe involved Left side O.K.
After 8 months: complete recovery 20.06.2006
33 yr: De Quervain Thyroiditis: diffuse disease
Amiodarone-induced destructive thyroiditis
Amiodarone.no typical sonographic pattern.normal appearance is possible.hypovascular
Benign lesions Thyroid adenomas Cystic lesions Goiter
True Thyroid Cyst
Colloidreflections: Comet s Tail
Goiter
Diffuse hyperplasia: homogenous Iodine deficiency: 34 yr Burundi living in Belgium for 5 years
Multinodular goiter longitunal transversal
83 yr : breathless when lying down Extreme narrowing of the trachea over a length of 5 cm
Thyroid tumors
Benign Tumors of the Follicular Epithelium: Follicular adenoma, variant Hürthle cell adenoma Differentiated Carcinomas of the Follicular Epithelium Papillary Thyroid Carcinoma Follicular Thyroid Carcinoma, variant Hürthle cell carcinoma Dedifferentiated Carcinoma: Anaplastic Thyroid Carcinoma
Follicular Adenoma Hürthle cell adenoma Follicular Adenocarcinoma Hürthle cell adenocarcinoma
23 yr: Follicular Adenoma
23 yr: Follicular Adenoma
25 yr: Follicular Carcinoma
79 yr: Follicular Carcinoma 9 cm
28.10.2003 56 yr: Evolution Follicular Carcinoma
26.09.2005: almost two years later
26.09.2005
26.09.2005
Hürthle cell adenoma: 58 yr A completely uniform halo around a nodule: suggestive of benignity
Hürthle cell carcinoma: 40 yr A complete avascular nodule is very unlikely to be malignant.
Papillary Thyroid Carcinoma Lymphatic spread Slow growth rate Multifocal
50 yr: Cystic papillary carcinoma
51 yr: Papillary carcinoma An ill-defined and irregular margin in a thyroid tumor suggests malignant infiltration of adjacent thyroid parenchyma
51 yr: Papillary carcinoma
Size of a nodule 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. The Society of Radiologists in Ultrasound recently recommended that the selection of a nodule for FNA in a multinodular thyroid be based primarily on US characteristics rather than nodule size Although nodules with a size of more than 4 cm are slightly more likely to be malignant than are smaller nodules, it is well known that benign nodules can reach a large size Jenny K. Hoang, Wai Kit Lee, Michael Lee, Daryl Johnson, and Stephen Farrell: US Features of Thyroid Malignancy: Pearls and Pitfalls RadioGraphics 2007; 27: 847-860.
31 yr: Multifocal Papillary Carcinoma
31 yr: Multifocal Papillary Carcinoma
36 yr: Follicular variant of Papillary Carcinoma
40 yr: Papillary Carcinoma: evolution after one year
19 yr: Adenopathies PapillaryCarcinoma.
17 yr: Papillary Carcinoma: numerous adenopathies
66j 1996: Thyroidectomy Papillary Carcinoma 2006: cystic metastases
Undifferiated: Anaplastic thyroid carcinoma Complex echotexture. Hyporeflective. Huge calcifications. Variable degrees of vascularisation, often poor.
66 yr: Anaplastic thyroid carcinoma
2 years later
78 yr 23.08.2005 03.07.2007
03.07.2007
80 yr: Anaplastic Carcinoma Isthmus
Medullary Thyroid Carcinoma Malignant tumor of the calcitonin - secreting parafollicular C - cells = medullary cells of the thyroid (non epithelial) Metastatic dissemination in partracheal and latero-cervical lymphnodes. Distant metastases (liver, lungs )
40 yr: Medullary Carcinoma right lobe MTC is usually firm in consistency, hypoechoic isoechoic Calcifications. Peripheral and central hypervascularity.
40 yr: Medullary Carcinoma right lobe. Multiple adenopathies. Calcitonine above measurable limits.
Mediastinal adenopathies and lungmetastases
Thyroid Metastases
49 yr: metastasis of lung cancer
74 yr: RCC
Conclusion Although there is some overlap between US appearance of benign nodules and that of malignant nodules, certain US features are helpful in differentiating between the two.
Thyroglossal duct cyst
46 yr Inflammatory surinfected thyroglossal duct cyst.
Before and after US-guided puncture with evacuation of 3 ml haemorrhagic fluid