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THYROID PATHOLOGY
Congenital Abnormalities
 Agenesis of the whole gland or one lobe of the thyroid.
Congenital absence of the entire thyroid. Note the empty fossae where the right and
left lobes would normally lie.
The carotid artery and jugular vein of both sides are seen in the color doppler
images.
http://www.ultrasound-images.com/thyroid.htm


Ectopic thyroid tissue
Thyroglossal duct cyst
Inflammatory and Immune Conditions
 Thyroiditis: causes swelling and tenderness of the thyroid which can be
caused by inflammation or autoimmune diseases.
Thyroid gland may appear enlarged and hypoechoic. +/- increased vascularity
 Sub Acute Thryoiditis: Diffuse enlargement of the thyroid gland which is often
painful.
 Hashimoto’s disease: also known as chronic autoimmune lymphatic thyroiditis
inflammatory disease of the thyroid usually characterised by diffuse
enlargement often associated with Hypothyrodism.
Hashimoto’s Thyroid with hypervascularity of Thyroiditis
http://www.sonographers.ca/data/storage/attachments/32daa114b821a66c72608430a73b5198.jpg

Graves’ disease: common cause of Hyperthyroidism. Diffuse thyroid gland
which may have an otherwise normal ultrasound appearance.
o the thyroid gland is often enlarged and can be hyperechoic
o the is a realtive absence of nodularity in uncomplicated cases.
o hyper vascular and may demonstrate a "thyroid inferno" pattern on colour
Doppler
http://images.radiopaedia.org/images/546363/f0c69534100632d7c0315b93c2a1ba_thumb.jpg
Cysts
 Are thought to represent cystic degeneration of a follicular adenoma.
 Usually benign, well defined with increased posterior acoustic enhancement.
http://www.alexfok.com/graphics/US%20Thyroid%20Cyst.jpg
Goitre
 Is enlargement of the whole gland, due to hyperplasia.
The degenerative changes within the goiter means they exhibit a range of
ultrasound appearances, anechoic lesions, debris filled lesions, bright
echogenic lesions, iso,hypo and hyperechoic lesions.
Multiple cystic lesions in both lobes of the thyroid. There is also evidence of few
nodular, solid masses within the lobes. Color doppler imaging reveals multiple
vessels around the lesions. Suggestive of a multinodular goitre.
http://www.ultrasound-images.com/admin/uploads/Thyroid-cysts-1b.jpg
Benign Adenoma or Colloid Lesions
 Areas with no ‘cold ‘uptake on a radioisope scan, within the thyroid gland.
 Benign solid tumor of the thyroid gland common thyroid nodule solid lesions
which may contain cystic areas that may undergo necrosis or haemorrhage
 Benign solid tumor of the parathyroid gland (which secretes parathyroid
hormone resulting in high serum calcium levels)
 A rim like calcification may also be seen with adenomas
 May have a halo of hyperechoic tissue and localized calcification.
http://radiology.rsna.org/content/247/3/762/F4.medium.gif
Thyroid Carcinoma
Malignancy occurs in approximately 1% of thyroid nodules. Papillary and/or mixed
papillary/follicular carcinomas are by far the most common malignancy. The
incidence is dramatically increased in post head/neck radiotherapy patients.
o Papillary Carcinoma 78%
o Follicular Lesion Carcinoma 17%
o Medullary Carcinoma 4%
o Anaplastic Carcinoma 1%
o Thyroid lymphoma - rare
o Thyroid metastases - rare
http://www.ultrasoundpaedia.com/normal-thyroid/
o Papillary Thyroid Carcinoma
1. Solid hypoechoic mass
2. Microcalicifications
3. Increased vascularity
4. Cervical lymph node metastasis
Left lobe- long section
Left lobe nodule-long with colour Doppler.
Transverse section of thyroid
Microcalcifications
http://www.ultrasound-images.com/thyroid.htm
o Follicular Carcinoma
 Irregular margins
 Thick irregular halo
 Tortuous and irregular blood vessels
Large, solid, echogenic, homogenous oval nodule with a hypoechoic halo around the
lesion, in the right lobe of thyroid.
http://www.ultrasound-images.com/admin/uploads/follicular-adenoma-1a.jpg
The lesion is solitary, shows no cystic areas and has a rim of vessels entering it's
central area. These ultrasound images are diagnostic of a benign follicular adenoma
of the thyroid.
http://www.ultrasound-images.com/admin/uploads/follicular-adenoma-1a.jpg
o Medullary Carcinoma
 May involve all gland or just small portion
 Bright echogenic foci within solid mass
 Cervical lymph node metastasis
Medullary thyroid carcinoma on ultrasound with typical small calcifications (arrows)
http://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Medulaeres_SDCa_mit_Verkalkungen.jpg/220px-Medulaeres_SD-Ca_mit_Verkalkungen.jpg
o Anaplastic carcinoma
 Hypoechoic
 May surround or invade blood vessels
 May invade neck muscles.
 Usually occurs over the age of 50
 Ill defined lesion with minimal cystic degeneration or echogenic foci.
Anaplastic thyroid carcinoma in an 84-year-old woman.
Transverse sonogram of the left lobe of the thyroid shows an advanced tumor with infiltrative
posterior margins (arrows) and invasion of prevertebral muscle.
http://radiographics.rsna.org/content/27/3/847/F7.small.gif
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