Download Normal Thyroid and Scanning Technique

NORMAL THYROID
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ROLE OF ULTRASOUND:
Ultrasound is a valuable diagnostic tool in assessing the following indications;
 Classification of a palpated lump. eg solid, cystic, mixed
 Evaluate adjacent structures
 Determining the location of a palpable lump (within or outside of the thyroid)
 Identifying a cause for Hyperthyroidism
 Identifying a cause for Hypothyroidism
 Post surgical complications eg abscess, oedema
 Multi Nodular Goiter (MNG): Follow up nodules
 Guidance of injection, aspiration or biopsy
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Relationship of normal anatomy and pathology to each other
LIMITATIONS, EQUIPMENT SELECTION AND TECHNIQUE:
 The inferior most aspect of an enlarged thyroid with marked retrosternal
extension will not always be visible on ultrasound.
 A 7-14mHz linear transducer
 Deep seated tumours, retrosternal thyroids or large patients may require a
curvi-linear array transducer of 3.5MHz
 Good colour / power / Doppler capabilities when assessing vessels or
vascularity of a structure.
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SCANNING OF THE THYROID
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Patient lies supine with their neck hyper-extended where possible; usually
placing a pillow under the shoulders will suffice.
Requires careful explanation of the procedure and asking the patient to refrain
from swallowing or moving when scanning aids the examination.
The thyroid gland and isthmus are examined in both planes, longitudinal and
transverse.
Extended field of view (where available) or panoramic views are used to
compare lobe size and echogenicity.
Landmarks should be included, especially in the transverse plane e.g.
Common Carotid Artery, neck muscles etc
Care should be taken to image the adjacent neck structures especially the
lymph node chains.
Transducer pressure on the neck when imaging the thyroid gland is often
uncomfortable. Resting the scanning arm on the table or patient’s upper chest
will help.
The normal images required to examine the thyroid are
1. Longitudinal image medial thyroid gland.
2. Longitudinal image mid thyroid gland.
3. Longitudinal image lateral thyroid gland.
4. Longitudinal image with a maximum length measurement.
5. Longitudinal image demonstrating colour flow within the thyroid gland.
6. Transverse image demonstrating the right and left lobes of the inferior
thyroid gland, dual imaging maybe required.
7. Transverse image demonstrating right and left lobes of the thyroid mid
gland.
8. Transverse image which demonstrates the right and left lobes of the thyroid
superior pole.
9. Transverse image and measurement of the mid thyroid- maximum
transverse and antero posterior measurement.
10.Colour Doppler image of blood flow within the thyroid gland.
11.Transverse image of the isthmus gland with antero posterior
measurement.
12.Longitudinal image of the Isthmus gland.
13.Transverse images of the right and left neck – lymph nodes lateral to the
thyroid gland.
14. Extra images required to complete the examination where extension of the
protocol is warranted.