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Thyroid Protocol
Structure
Isthmus
with
RT and LT
Lobes
Isthmus
Scan Plane
Transverse
Label
ISTHMUS
Transverse
ISTHMUS
ISTHMUS
RT LOBE TX SUP
RT LOBE TX MID
RT LOBE TX MID
RT LOBE TX INF
RT NECK SAG
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RT LOBE SAG LAT
RT LOBE SAG MID
RT LOBE SAG MID
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RT LOBE SAG MID
RT LOBE SAG MEDIAL
LT LOBE TX SUP
LT LOBE TX MID
LT LOBE TX MID
LT LOBE TX INF
LT NECK SAG
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LT LOBE SAG LAT
LT LOBE SAG MID
LT LOBE SAG MID
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LT LOBE SAG MID
LT LOBE SAG MEDIAL
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Transverse
RT Lobe/
Neck
Sagittal
Transverse
Lt Lobe/
Neck
Sagittal
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Landmarks
Isthmus
RT lobe of thyroid
Left lobe of thyroid
Longus coli
o Use virtual convex or dual screen mode if necessary
Isthmus with clear anterior and posterior borders
Isthmus with AP measurement
RT lobe thyroid superior
RT lobe thyroid mid
RT lobe thyroid mid with width measurement
RT lobe thyroid inferior
Neck Muscles
o Document any abnormal lymph nodes seen
RT lobe thyroid lateral
RT lobe thyroid mid
RT lobe thyroid mid with length and AP measurements
o Use virtual convex or dual screen mode if necessary
RT lobe thyroid mid with color Doppler
RT lobe thyroid medial
LT lobe thyroid superior
LT lobe thyroid mid
LT lobe thyroid mid with width measurement
LT lobe thyroid inferior
Neck Muscles
o Document any abnormal lymph nodes seen
LT lobe thyroid lateral
LT lobe thyroid mid
LT lobe thyroid mid with length and AP measurements
o Use virtual convex or dual screen mode if necessary
LT lobe thyroid mid with color Doppler
LT lobe thyroid medial
Anatomical/Image Correlation- www.steadyhealth.com/.../4540/Image/thyroid1.jpg
Mid
Superior
Mid
Medial
Inferior
Lateral
Transverse Images
Images
AK\backup\Abdomen
II\protocols
Sagittal Images
Thyroid Protocol
Normal Measurement Ranges
Structure
Isthmus
Area of Interest
Isthmus midline
Plane
Transverse
Measurement
4-6 mm
Comments
Measure anterior to posterior
Lobes
Length
Sagittal
4-6 cm
Height (A/P
thickness)
Sagittal
.5-2cm
Width
Transverse
2-4 cm
Mid portion measure superior to inferior
*Use virtual convex or dual screen when
applicable
Mid portion measure anterior to posterior
*Some physicians may want this
measurement in the transverse plane
(Clarify before exam)
Mid portion measure medial to lateral
Tips -You should understand completely why you stored the image and identify everything in the image
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You must always evaluate the entire organ first before you store an image
Make sure you look lateral to the thyroid for pathology
Make sure you look above and below the thyroid for pathology
You are looking for enlarged lymph nodes or parathyroid glands
Normal lymph nodes are elliptical/ bean-shaped and have a hypoechoic cortex with an echogenic hilum
Normal parathyroid glands are not visualized sonographically
Document what you see - this is EXTREMELY IMPORTANT!!!
Labs to Evaluate
 TSH (thyroid stimulating hormone)- used to identify thyroid disease
 T4 (thyroxine)- reflects thyroid hormone activity
 T3 (Triiodothyronine)- provides information regarding function of the thyroid
Pathology - If pathology is present you must document the pathology in its entirety. Images should include:
 Gray scale sagittal and transverse images
 Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
 Color Doppler image to document the presence of blood flow and spectral Doppler image to document the type and
velocity of blood flow
AK\backup\Abdomen II\protocols