thyriod gland imaging part 2 (full story diffuse thyriod disease) dr ahmed esawy
TRANSCRIPT
-
DIFFUSE
THYRIOD GLAND DISEASE
IMAGING
Dr Ahmed Esawy
-
Dr. Ahmed Eisawy
MBBS M.Sc MD
Dr Ahmed Esawy
-
Scheme demonstrating how thyroid lobes should be measured in the longitudinal and transverse axis
Dr Ahmed Esawy
-
A lower frequency transducer can be used to provide a better scope image (convex transducer) in patients with GD when presenting large goiters. The image shows the transverse axis of the thyroid (a), longitudinal axis of the right lobe (b) and longitudinal axis of the left lobe (c).
Dr Ahmed Esawy
-
Normal gland has an echogenicity characteristic in ultrasound, easily distinguishable from adjacent muscular structures. Notice in figure (a) greater ecogenicity in thyroid (straight arrow) relative to the neck muscles (curved arrow) and,in figure (b) bigger or equal to the submandibular glands.
Dr Ahmed Esawy
-
State of thyroid blood perfusion Perfusion of the thyroid increases on several occasions:
increased cardiac output (a stressed patient),
in gravidity,
during an active autoimmune inflammation active Graves disease or Hashimotos thyroiditis ((in active Graves disease thyroid inferno).
hyperfunctioning nodules
untreated primary hypothyroidism because of TSH stimulation.
decreased perfusion in breakdown of the thyroid tissue as is the case of
postpartum thyroiditis,
De Quervain thyroiditis
amiodarone-induced thyrotoxicosis type 2.
Dr Ahmed Esawy
-
PSV normal up to 25 cm/sec
PSV at thyrotoxicosis more than 100 cm/sec
PSV at hypothyroidism 50-60 cm/sec
Dr Ahmed Esawy
-
DIFFUSE GIOTRE the whole thyroid appearing to be enlarged Size
hyperthyroidism Graves disease Suppurative thyroiditis Drug-induced thyroiditis Riedel s thyroiditis Iodine deficiency Organification defect pregnant ,menopause thyroiditis Silent thyroiditis
hypothyroidism Hshimoto s thyroiditis Iodine deficiency Radiation exposure Sub acute thyroiditis post partum thyroiditis
Dr Ahmed Esawy
-
Sonographic Findings of Diffuse
Thyroid Disease
Gland enlargement Normal volume
19.6 +/-4.7 ml for men, 17.5 +/-4.2 ml for women, scaling with BMI Isthmus over 5 mm Variants: normal size and small gland
Altered parenchymal echotexture and/or echogenicity Increased vascularity Most marked in Graves Lymphadenopathy usually minimal and in the central compartment
Dr Ahmed Esawy
-
Enlarged Thyroid with Normal Echogenicity and Echotexture
Normal variation-Height, BMI, Gender, Race, Age Mild iodine deficiency Medical conditions: pregnancy, renal disease Subclinical autoimmune thyroid disease Check serum TSH
Dr Ahmed Esawy
-
ULTRASOUND IN DIFFUSE HYPERTHYRIODISM
THYROTOXICOSIS
Dr Ahmed Esawy
-
INCREASE THYRIOD HORMONE
Thyrotoxicosis refers to the manifestation of excessive quantities of circulating thyroid hormone
Hyperthyroidism refers only to the subset of thyrotoxic diseases caused by the overproduction of the thyroid hormone by the gland itself.
Dr Ahmed Esawy
-
differential diagnoses for thyrotoxicosis Graves disease: Subacute thyroiditis: Silent thyroiditis: painless thyroiditis, which may be seen in postpartum women (postpartum thyroiditis); a self-limited course; and low radioiodine uptake. Multinodular toxic goiter: Toxic adenoma: Factitious thyrotoxicosis: Special features include no goiter, a low thyroglobulin level, and low radioiodine uptake. Iatrogenic thyrotoxicosis: thyroid hormone intake.Iodide-induced thyrotoxicosis: iodine-containing contrast agents or drugs such as amiodarone. Thyrotropin-secreting pituitary adenoma: Beta-human choriogonadotropininduced thyrotoxicosis:.
Dr Ahmed Esawy
-
Graves Disease
= DIFFUSE TOXIC GOITER = autoimmune disorder with thyroid-stimulating antibodies (LATS) producing hyperplasia + hypertrophy of thyroid gland
Dr Ahmed Esawy
-
Marked increase in gland size; less commonly normal or minimally enlarged Echotexture may be normal or diffusely hypoechoic Decreased echogenicity,Heterogeneous echotexture spotty parenchymal echo pattern Smooth or lobular surface ,rounded contour increased vascularity with (turbulent flow with arterial-venous shunts) (thyroid inferno) Prominent extra-thyroidal vessels Peak systolic velocity of 40 cm/sec or higher has 96% sensitivity and 95% specificity for GD Marked thyroid arteries velocity increase
ULTRASOUND CRITERIA Graves Disease
Dr Ahmed Esawy
-
The parenchymal hypoechogenicity is due to decrease in colloid content and increased cellularity resulting in reduction of colloidcell interface, and/or hypervascularity. persistence of parenchymal hypoechogenicity after cessation of medical therapy is associated with relapse of hyperthyroidism
Dr Ahmed Esawy
-
Graves Disease
Causes Autoimmune
hyperthyroidism
Sonographic Findings Diffuse enlargement
Hypoechoic without
palpable nodules
Markedly increased
vascularity (thyroid
inferno)
Dr Ahmed Esawy
-
Ultrasound scanner must be adjusted to gland for correct evaluation following specific thyroid protocol. Special attention to the velocity scale that must always be equal or less than 50 cm/s, to thyroid arteries systolic peak velocity measurement
Dr Ahmed Esawy
-
Transverse (a) and longitudinal (b) power Doppler ultrasound shows the markedly increased parenchymal vascularity in Graves disease giving the appearance of thyroid inferno
Dr Ahmed Esawy
-
Graves disease is an autoimmune thyroid disease and is the most common cause of thyrotoxicosis (up to 85%). Ultrasound thyroid gland is often enlarged and can be hyperechoic heterogeneous thyroid echotexture relative absence of nodularity in uncomplicated cases hypervascular; may demonstrate a "thyroid inferno" pattern on colour Doppler
Dr Ahmed Esawy
https://radiopaedia.org/articles/autoimmune-thyroid-diseasehttps://radiopaedia.org/articles/thyrotoxicosishttps://radiopaedia.org/articles/thyroid-inferno
-
Graves disease
Diffusely enlarged, hypoechoic, increased vascularity (thyroid inferno) Dr Ahmed Esawy
-
Graves disease
PSV HIGH
Dr Ahmed Esawy
-
Graves Disease
Ultrasound of the thyroid showing an intense vascularity on color Doppler that is consistent with an inferno.
Dr Ahmed Esawy
-
Ultrasound of the thyroid showing an intense vascularity on color Doppler that is consistent with an inferno.
Dr Ahmed Esawy
-
Enlarged gland Decreased echogenicity Heterogeneous echotexture
Graves
Normal Dr Ahmed Esawy
-
Graves Disease
Marked increase in gland size; less commonly normal or minimally enlarged Echotexture may be normal or diffusely hypoechoic Smooth or lobular surface contour
Dr Ahmed Esawy
-
Diffuse increased vascularity : thyroid inferno Prominent extra-thyroidal vessels Peak systolic velocity of 40 cm/sec or higher has 96% sensitivity and 95% specificity for GD
Graves Disease
Dr Ahmed Esawy
-
Graves with Occult PTC
Dr Ahmed Esawy
-
Graves with patchy regions:Lymphocytic infiltrate on FNA
Dr Ahmed Esawy
-
CT scan shows thyroid gland to have diffusely decreased attenuation
Contrast-enhanced CT scan shows enlarged right thyroid lobe with decreased attenuation (arrow).
Dr Ahmed Esawy
-
62-year-old woman with goitrogenic enlargement of the thyroid gland. Contrast-enhanced CT images (ac) show goitrogenic enlargement, parenchymal heterogeneity, and calcification of the thyroid gland. The thyroid gland extended to the mediastinum (a) with unilateral retropharyngeal elongation at the level of the left piriform sinus (c, arrows).
Dr Ahmed Esawy
-
a, b. A 51-year-old woman with goitrogenic enlargement of the thyroid gland and progressive dyspnea, wheezing, and stridor. Unenhanced CT images (a, b) show prominent goitrogenic enlargement and parenchymal heterogeneity of the thyroid gland and mild stenosis of the larynx (a). Bilateral retropharyngeal extension of the thyroid gland was caused by narrowing of the oropharynx at the level of the mandible (b, arrows).
Dr Ahmed Esawy
-
Dr Ahmed Esawy
-
Tracheal Compression
Dr Ahmed Esawy
-
Thyroid scintigraphy in Graves disease shows the thyroid gland is usually enlarged
Dr Ahmed Esawy
-
palpable cold nodule in a patient with Graves disease has a high likelihood of malignancy (4%)
mnemonic: CATCH LAMP
Colloid cyst
Adenoma (most common)
Thyroiditis
Carcinoma
Hematoma
Lymphoma, Lymph node
Abscess
Metastasis (kidney, breast)
Parathyroid
Probability of a cold nodule to represent thyroid cancer:
Dr Ahmed Esawy
-
Graves Disease
24/M
(+) thyrotoxic symptoms
131I thyroid scan & uptake Diffuse thyromegaly
Elevated RAI uptake values
Dr Ahmed Esawy
-
Diffuse Toxic Goiter
30/F
Palpitations, excessive sweating, irritability, anterior neck enlargement
99mTcO4 thyroid scan
Diffuse thyromegaly
Scintigraphic evidence of increased gland uptake function
38 sec acquisition time
Reduced background tracer activity
Dr Ahmed Esawy
-
Graves disease
Dr Ahmed Esawy
-
Thyroid scintigraphy of the Graves disease patient showed enlarged both lobes of the thyroid with diffuse increase uptake. R: Right; Tc99m: Technetium TC 99M pyrophosphate.
Dr Ahmed Esawy
-
Diffuse thyroiditis
Dr Ahmed Esawy
-
A number of inflammatory conditions can affect the thyroid gland, which are commonly described as thyroiditis : 1-acute thyroiditis
acute suppurative thyroiditis (AST) 2-autoimmune thyroiditis
subacute lymphocytic thyroiditis: silent thyroiditis or painless subacute thyroiditis
postpartum thyroiditis: is a subtype of silent thyroiditis Riedel thyroiditis Hashimoto thyroiditis: chronic lymphocytic thyroiditis Graves disease
3-subacute thyroiditis granulomatous: de Quervain thyroiditis: subacute granulomatous thyroiditis lymphocytic: subacute lymphocytic thyroiditis: silent thyroiditis or painless subacute thyroiditis
postpartum thyroiditis: is a subtype of silent thyroiditis Dr Ahmed Esawy
https://radiopaedia.org/articles/thyroid-glandhttps://radiopaedia.org/articles/missing?article[title]=acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=acute-suppurative-thyroiditis-asthttps://radiopaedia.org/articles/missing?article[title]=acute-suppurative-thyroiditis-asthttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/subacute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/subacute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/subacute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/subacute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/post-partum-thyroiditishttps://radiopaedia.org/articles/riedel-thyroiditishttps://radiopaedia.org/articles/hashimoto-thyroiditishttps://radiopaedia.org/articles/graves-diseasehttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/post-partum-thyroiditis
-
Thyroiditis is the most common group of inflammatory disorders affecting the thyroid gland and is encountered very often in clinical practice. Thyroiditis can be painful or painless . The suggested classification of thyroiditis is acute, sub acute and chronic.
Dr Ahmed Esawy
-
Thyroiditis
Hypothyroidism Hashimoto Subacute de Quervain thyroiditis
hyperthyroidism as GRAVE disease Post partum Suppurative thyoiditis
euthyroid
Dr Ahmed Esawy
https://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditis
-
Thyroiditis
Acute thyroiditis usually has a bacterial etiology and can be very painful
The chronic lymphocytic type of thyroiditis is Hashimotos and it is known to have an autoimmune basis
Subacute thyroiditis usually presents with a transient hyperthyroidism followed by hypothyroidism
The lymphocytic kind, which is silent thyroiditis [has an unknown pathogenesis or is autoimmune]
the granulomatous kind, which is painful [and typically has a viral etiology]. de Quervain thyroiditis Dr Ahmed Esawy
https://radiopaedia.org/articles/de-quervain-thyroiditis
-
A diffuse or multifocal decrease in echogenicity demonstrated on ultrasound is the hallmark of many types of thyroiditis. This decrease in echogenicity may be due to
A-increase in the intrathyroidal blood flow B-increased cellularity of the thyroid follicles C-decreased colloid production and or lymphocytic infiltration.
On color and power Doppler studies, increased blood flow is noted throughout the gland. This constellation of findings of reduced echogenicity of the gland with an increased vascularity is highly suggestive of a diffuse thyroiditis. In addition, the gland is often heterogeneous.
Dr Ahmed Esawy
-
Return of the normal thyroid echogenicity and blood flow is noted on resolution of the disease. However heterogeneity may persist if the chronic thyroiditis ensues [fibrosis may set in within the gland, resulting in a coarsened echotexture . Radioactive iodine uptake testing can aid in identifying the various etiologies of hyperthyroidism and also help in patient selection for I-131 treatment.
Dr Ahmed Esawy
-
Peak systolic velocities of the inferior thyroid arteries were significantly higher in patients with Graves disease than in patients with thyroiditis
differentiation of Graves' disease and thyroiditis in thyrotoxicosis
The thyrotoxicosis clinical manifestations in thyroiditis and mild or initial GD can be difficult to differentiate
Dr Ahmed Esawy
-
Comparative table of sonographic findings in the normal thyroid gland, in thyroiditis and in Graves disease.
Dr Ahmed Esawy
-
A 25 year old femae presents with a one week history of a tender midline swelling of the neck. She also had complaints of palpitations and fine tremors of the hand. Laboratory features revealed increased levels of T3 and T4 and decreased TSH level
Differential DiagnosisDiffuse thyroiditis
Diffuse thyroiditis
subacute viral thyroiditis
Dr Ahmed Esawy
-
Gray scale ultrasound, color Doppler, Doppler spectral analysis in patients with Graves disease. A: Gray scale ultrasound of the right lobe of the thyroid gland in patients with Graves disease shows enlarged gland with smooth contour and heterogeneous echotexture; B: Color Doppler of the same patient shows diffuse increase vascularity of the thyroid gland; C: Doppler spectral analysis of the right inferior thyroid artery of the same patients show elevated peak systolic velocity (V1 = 89.8 cm/s) and elevated end diastolic velocity (V2 = 44.9 cm/s)
Dr Ahmed Esawy
-
Qualitative (gland visual vascularization impression) and quantitative (thyroid arteries peak systolic velocity) assessment of thyroid gland. Diffuse increase of the parenchyma vascularization, known as thyroid inferno, in color Doppler (a) and power Doppler (b), before GD treatment or effective therapy
Measurement of right inferior thyroid artery peak systolic velocity in spectral analysis (c), demonstrating the increased speed in patients with GD not treated or not responsive to treatment.
Dr Ahmed Esawy
-
Changes to the characteristic features of normal gland, in GD are seen to B mode sonographic. Diffuse heterogeneity and hypoechogenicity, with dense fibrotic beams permeating in the longitudinal axis of the right lobe (a), longitudinal axis of the left lobe (b) and transverse axis of the thyroid (c).
Dr Ahmed Esawy
-
Color Doppler demonstrating a diffuse increase of the parenchyma vascularization, known as thyroid inferno.
Dr Ahmed Esawy
-
Thyroid arteries systolic peak velocity measurement is done 1 mm sample volume adjustment, in vessel centre, the insonation angle shoud be 0 - 60 and correction angle adjusted parallel to the vessel wall. Dr Ahmed Esawy
-
Systolic peak velocity above 100 cm/s in the inferior thyroid artery, can be reached for patients with Graves disease not treated or not responsive to treatment
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular goitre (MNG) enlarged thyroid gland (i.e. goitre) due to multiple nodules which may have normal, decreased or increased (toxic nodule /TMNG) function. most commonly clinically euthyroid but may be hyperthyroid or borderline
Dr Ahmed Esawy
https://radiopaedia.org/articles/thyroid-glandhttps://radiopaedia.org/articles/goitre
-
sonographic appearance of MNG Well marginated,diffuse enlargement of the thyroid gland with a heterogeneous, nodular appearance . The presence of calcification, fibrosis, cystic change and haemorrhage contribute to the heterogeneous appearance.
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows the typical appearance of multinodular goitre as a wellmarginated, diffuse enlargement of the thyroid gland with a heterogeneous, nodular appearance (arrows).
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows the spongiform appearance (arrows) of aggregation of multiple microcystic components in >50% of the nodule volume that is highly specific for benign hyperplastic nodule
Dr Ahmed Esawy
-
Longitudinal grey scale ultrasound shows a predominantly cystic nodule. The solid component (curved arrow) within the cystic component * is due to blood clot, and invariably avascular on Doppler
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows the tiny, nonshadowing echogenic foci with comet-tail artifacts (arrows) that are highly suggestive of colloid content. Dr Ahmed Esawy
-
Dr Ahmed Esawy
-
Dr Ahmed Esawy
-
Micronodular pattern does not equalmulitnodular goiter
Dr Ahmed Esawy
-
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
MNG
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
Multinodular Goiter
Dr Ahmed Esawy
-
non-enhanced CT showing coarse calficifactions in a multinodular goiter, representing degenerative regressive calcifications
Dr Ahmed Esawy
-
contrast enhanced CT showing mostly eggshell-like calficied hypodense nodules in a multinodular goiter.
Dr Ahmed Esawy
-
A, Axial T2-weighted image shows large mass located in right thyroid lobe (arrow) with strong heterogeneous hyperintensity.
B, Apparent diffusion coefficient (ADC) map shows high ADC value (2.20 103 mm2/s) in lesion (arrow)
71-year-old woman with adenomatous goiter.
Dr Ahmed Esawy
-
Unenhanced axial CT scan shows diffuse decrease in the attenuation of the thyroid gland (black arrow), which is isoattenuated to the muscle. White arrow indicates the sternocleidomastoid muscle.
Contrast-enhanced axial CT scan shows slight enlargement of the left thyroid lobe. Decreased attenuation can be seen in the posterior portion of the left thyroid lobe (curved arrow), and slightly decreased attenuation can be seen anteriorly in the right thyroid lobe (straight arrow).
Dr Ahmed Esawy
-
Sub sternal mediastinal extension Tracheal compression
Dr Ahmed Esawy
-
Trachea, stenosis. Chest radiograph shows an intrathoracic goiter with tracheal compression and deviation (arrows).
Dr Ahmed Esawy
-
Trachea, stenosis. Axial CT scan in a patient with an intrathoracic multinodular goiter (MNG), which is compressing the trachea.
Dr Ahmed Esawy
-
Trachea, stenosis. Axial CT scan in a patient with a multinodular goiter (MNG) compressing the cervical trachea.
Dr Ahmed Esawy
-
Trachea, stenosis. CT scan shows an intrathoracic goiter compressing the trachea.
Dr Ahmed Esawy
-
Multinodular goiter. Axial contrast-enhanced CT scan demonstrates multiple low-attenuating nodules in an enlarged gland.
Goiter. Axial contrast-enhanced CT scan demonstrates tracheal stenosis due to external compression.
Dr Ahmed Esawy
-
Goiter. Enhanced CT reveals an enhancing heterogeneous soft-tissue mass (arrows) that originated in the thyroid gland and descended through the thoracic inlet deviating the trachea (asterisk) to the right.
Dr Ahmed Esawy
-
Other causes of thyrotoxicosis
Dr Ahmed Esawy
-
Interferon related Thyroiditis:Serum TSH 12mU/L
Dr Ahmed Esawy
-
More commonly patients develop hypothyroidism due to iodine content The minority develop thyrotoxicosis Type 1 is an iodine load-induced hyperthyroidism which occurs in abnormal glands (MNG or Graves); increased vascularity Type 2 is a destructive thyroiditis; normal gland; normal or decreased vascularity; low/absent upatke on RAIU
Amiodarone-Induced Thyrotoxicosis (AIT)
Dr Ahmed Esawy
-
74 yo man on Amiodarone for several years now with hyperthyroidism
Dr Ahmed Esawy
-
amiodarone
TUS image in a 69-year-old patient who developed hypothyroidism after treatment by amiodarone.
Dr Ahmed Esawy
-
Amiodarone Thyroiditis
Dr Ahmed Esawy
-
Rarely acute suppurative thyroiditis cause thyrotoxicosis
Dr Ahmed Esawy
-
Infection commonly starts in the perithyroid soft tissues Abscesses, both intra- and extrathyroid in locations, (appear as ill-defined, hypoechoic heterogeneous lesions with internal debris. Internal septa or gas may be present) Adjacent inflammatory/reactive nodes are usually seen guiding needle aspiration of the abscess
Dr Ahmed Esawy
-
Transverse grey scale ultrasound in acute suppurative thyroiditis shows a focal abscess in the left lobe of thyroid in the form of an ill-defined hypoechoic lesion (arrow) with adjacent inflammatory thickening. The common carotid aretries (arrowheads) and the left internal jugular vein (curved arrow) are intact.
Dr Ahmed Esawy
-
Axial contrast enhanced CT of the focal thyroid abscess as an ill-defined poorly enhancing hypodense lesion (arrow). The common carotid arteries (curved arrows) and internal jugular veins (arrowheads) are intact and patent
Dr Ahmed Esawy
-
barium swallow study show delineates the left pyriform fossa sinus (arrows) associated with a fourth branchial cleft anomaly.
Dr Ahmed Esawy
-
Computed tomography scan showed a large, multiseptated, low attenuated mass in the right thyroid lobe and enlarged lymph node in the right neck level IV, V, and VI areas.
Ultrasonography of the neck revealed a right thyroid mass of about 4.52.54.6 cm with heterogeneously increased internal echogenicity
Acute Suppurative Thyroiditis
Dr Ahmed Esawy
-
2-year-old boy with acute suppurative thyroiditis. Contrast-enhanced CT shows a fluid collection (arrows) with internal gas (arrowhead) involving left lobe of thyroid gland (open arrows) and adjacent soft tissue.
Dr Ahmed Esawy
-
Dr Ahmed Esawy
-
Riedels thyroiditis
is a chronic sclerosing replacement of the gland that is exceedingly rare. The process extends to adjacent structures
Synonyms include ligneous thyroiditis and invasive fibrous or chronic sclerosing thyroiditis. This condition is characterized by overgrowth of connective tissue which often extends into neighboring structures.
Dr Ahmed Esawy
-
Thyroid Ultrasound in hypothyroidism
Dr Ahmed Esawy
-
HYPOTHYRIODISM
CONGENITAL Dysgenesis ectopic thyriod (Sublingual thyroid) Agenesis Hypoplasia Hemiagenesis
ACQUIRED
primary(thyroid failure) Secondary (Central) pituitary TSH deficit hypothalamic deficiency Peripheral resistance to the thyroid hormones
Dr Ahmed Esawy
-
CONGENITAL HYPOTHYRIODISM
Transient: P/o maternal antibodies due to a thyrotropin receptor blocking antibody; maternal ingestion of antithyroid medication or iodine overload caused by exposure to iodine containing antiseptics.
Permanent: 80 % of them are caused by: Aplasia, hypoplasia, hemiplasia or ectopy 15- 20% results from dyshormonogenesis.
Dr Ahmed Esawy
-
HYPOTHYRIODISM
PRIMARY(thyroid failure) 1-Hashimotos thyroiditis A/ with goiter B /thyroid atrophy end-stage autoimmune thyroid disease, following either Hashimotos thyroiditis or Graves disease 2. Subacute thyroiditis 3. Thyroidectomy or therapy for hyperthyroidism (drugs, 131I amiodarone) 4. Excessive iodide intake 5. Other causes A/ Iodide deficiency B/ Goitrogens C/ Inborn errors of thyroid hormone synthesis 6-Amyliodosis infiltration
Secondary (Central) pituitary TSH deficit hypothalamic deficiency (pituitary adenoma, pituitary ablative therapy, or pituitary destruction Hypothalamic destruction )
Peripheral resistance to the thyroid hormones Dr Ahmed Esawy
-
HYPOTHYRIODISM
Goitrus
Non-Goitrus
Iodine deficiency (diffuse goitre which often becomes nodular . The perfusion is normal. Enlargement of the thyroid gland is an adaptive process in low iodine intake)
Dr Ahmed Esawy
-
State of thyroid blood perfusion Perfusion of the thyroid increases on several occasions:
increased cardiac output (a stressed patient),
in gravidity,
during an active autoimmune inflammation active Graves disease or Hashimotos thyroiditis ((in active Graves disease thyroid inferno).
hyperfunctioning nodules
untreated primary hypothyroidism because of TSH stimulation.
decreased perfusion in breakdown of the thyroid tissue as is the case of
postpartum thyroiditis,
De Quervain thyroiditis
amiodarone-induced thyrotoxicosis type 2.
Dr Ahmed Esawy
-
PSV normal up to 25 cm/sec
PSV at thyrotoxicosis more than 100 cm/sec
PSV at hypothyroidism 50-60 cm/sec
Dr Ahmed Esawy
-
Congenital hypothyroidism
Dr Ahmed Esawy
-
Reference Standard for Thyroid Size (cm) by Age
Dr Ahmed Esawy
-
Congenital hypothyroidism: Ultrasound
Dr Ahmed Esawy
-
Congenital hypothyroidism: Scintigraphy
Dr Ahmed Esawy
-
Congenital hypothyroidism: Dyshormonogenesis
Dr Ahmed Esawy
-
10-day-old girl with sublingual thyroid gland..
Dr Ahmed Esawy
-
Ultrasound: Less sensitive in detecting ectopic thyroid (although has high specificity) NM thyroid scintigraphy : Tc 99m pertechnetate or I -123
Dr Ahmed Esawy
-
14-day-old girl with thyroid agenesis.
Dr Ahmed Esawy
-
7-day-old boy with thyroid hemiagenesis.
Dr Ahmed Esawy
-
20-day-old girl with hemiagenesis and sublingual thyroid.
Dr Ahmed Esawy
-
9-day-old boy with thyroid gland in normal location. Dr Ahmed Esawy
-
Parents can be counseled on either the certainty of lifetime therapy (for dysplastic thyroid) or the possibility of later discontinuing therapy (for eutopic thyroid, because CH may be transient in these children). If the dysplastic thyroid gland is absent or ectopic (usually a small sublingual gland), parents can be told that the infant will need lifetime thyroid therapy. If the thyroid gland is present in the normal position (eutopic) and the condition is transient (as shown by controlled withdrawal of thyroid in older children),lifelong treatment may not be needed.
Congenital hypothyroidism: How does imaging help?
Dr Ahmed Esawy
-
Chronic Lymphocytic (Hashimotos) Thyroiditis
Dr Ahmed Esawy
-
Hashimotos thyroiditis
Destructive autoimmune disorder which leads to chronic inflammation of gland
Enlargment not necessarly symmetric
Young Middle aged female
Dr Ahmed Esawy
-
classical sonographic appearance diffuse, moderately enlarged, hypoechoic gland obulated contours heterogeneous echo pattern fine, echogenic fibrotic streaks within. The vascularity varies with the stage and type of involvement
Dr Ahmed Esawy
-
Hashimotos thyroiditis Three stages
-Acute : enlarged in size
decreased vascularity
or hypervascularity in Hashimoto thyroiditis is never as marked
as in Graves disease, and the flow velocities are within
normal limits
discrete nodules occur in nearly equal frequency against a
background normal thyroid parenchyma
Those nodules with background Hashimoto thyroiditis tend to be solitary, solid, non-calcified, hyperechoic and haloed, while those nodules without background of Hashimoto thyroiditis
Ill-defined, patchy hypoechoic areas (~26 mm) separated by
echogenic fibrous septa may be seen Representing lymphocyte infiltration and echogenic rims due to fibrous septa
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows diffuse hypoechoic goitre (arrows) with ill-defined patchy hypoechoic areas separated by echogenic fibrous septa (curved arrow) in acute diffuse Hashimoto thyroiditis.
Dr Ahmed Esawy
-
chronic Hashimoto thyroiditis enlarged, hypoechoic, micronodular gland with lobulated contours. Diffuse, hypoechoic parenchymal echoes giving the appearance of ghost-like thyroid atrophic/end stage, Hashimoto thyroiditis small, hypoechoic gland with heterogeneous echo pattern, and usually hypovascular on Doppler
Dr Ahmed Esawy
-
Hashimotos Clinical Signs
Most common form of thyroiditis
Autoimmune chronic inflammation
Diffuse enlargement
possibly asymmetric
Painless
may develop mild pain over time
Eventual hypothyroidism
Young middle aged females
Sonographic Findings:
Increased Vascularity with Color Doppler
Texture is course and homogenous with
multiple ill-defined hypoechoic areas
separated by thick fibrous strands
Over time, the gland becomes fibrotic, ill-
defined, and heterogeneous
Dr Ahmed Esawy
-
Gland size enlarged, normal or small Parenchymal hypoechogenicity Diffuse or patchy regions May precede antibody positivity (15% pts) Fibrosis common Vascularity Variable, correlates with immune response Lymphadenopathy Common in the central compartment
Sonographic Appearance of Chronic Lymphocytic Thyroiditis (Hashimoto thyroiditis)
Dr Ahmed Esawy
-
Hashimotos thyroiditis
Sonographic features :
diffusle enlarged and coarse parenchyma
heterogenous texture
Multiple hypoechioc nodules in both lobes
Dr Ahmed Esawy
-
Hashimotos thyroiditis
Dr Ahmed Esawy
-
Hashimotos thyroiditis (late stage)
Heterogeneous and coarse parenchyma Multiple small hypoechoic nodules surrounded by an echogenic rim of fibrosis Vascularity : Variable; increased early in the disease and decreased later in the disease course
Dr Ahmed Esawy
-
diffusely coarse echotexture with innumerable tiny hypoechoic nodules that may become confluent, interspersed with echogenic fibrous bands. Vascularity may be increased, decreased, or normal, and FNA is usually not necessary for diagnosis.
painless enlarged thyroid usually in a hypothyroid state .few in hyperthyriod state
Hashimotos thyroiditis
Dr Ahmed Esawy
-
Chronic lymphocytic (Hashimoto) thyroiditis in a 53-year-old woman with a swollen thyroid. (a) Longitudinal duplex US image shows diffusely heterogeneous thyroid parenchyma with abnormal diffusely increased vascular flow.
Dr Ahmed Esawy
-
TUS image of the right thyroid lobe in a patient with Hashimotos thyroiditis with a large goitre.
Dr Ahmed Esawy
-
Nodular Hashimotos thyroiditis
Homogeneously echogenic nodule with a hypoechoic rim: white knight
Dr Ahmed Esawy
-
Typical TUS image of Hashimotos thyroiditis (TSH 17 mIU/l, highly positive thyroid autoantibodies). Note the inhomogenous and hypoechogenic thyroid texture.
Dr Ahmed Esawy
-
Preclinical stage: Scintigraphy may show increased uptake
Difficult to distinguish Hashitoxicosis from
Graves disease by US or scintigraphy.
Dr Ahmed Esawy
-
Hashimotos thyroiditis is often asymmetric Can be a solitary focal lesion Accounts for up to 10% of focal lesions May still require FNA
Focal Hashimotos thyroiditis
Dr Ahmed Esawy
-
Focal Thyroiditis
Hashimotos thyroiditis is often asymmetric Can be a solitary focal lesion Accounts for up to 10% of focal lesions May still require FNA
Dr Ahmed Esawy
-
Focal chronic autoimmune thyroiditis represented by a hypoechoic, partially defined nodule (A) demonstrating hypervascularization at amplitude color Doppler (B).
Dr Ahmed Esawy
-
Hashimotos Thyroiditis
Hashimotos Thyroiditis normal
Dr Ahmed Esawy
-
Multiple hypoechoic, ill-defined nodules 1-6mm in size Geographic hypoechoic areas Linear white lines representing fibrosis Interrupted capsule Variable vascularity
Hashimotos Thyroiditis
Dr Ahmed Esawy
-
Hashimotos Thyroiditis
Dr Ahmed Esawy
-
Are these nodules
Dr Ahmed Esawy
-
these are not nodules Cleft sign
Dr Ahmed Esawy
-
Patchy thyroiditis vs. nodules
Dr Ahmed Esawy
-
Over time the gland tends to become more hypoechoic and enlarged Palpable surface nodularity Pseudonodular sonographic appearance End-stage may be a small and irregular gland
Hashimotos Thyroiditis
Dr Ahmed Esawy
-
Hashimotos Thyroiditis
Dr Ahmed Esawy
-
PTC in Hashimotos
Dr Ahmed Esawy
-
Typical PTC features overlap with HT features Hyopechogenicity, solid consistency, irregular or infiltrating margins Key finding is pattern of calcifications Clustered microcalcifications or dystrophic calcifications Asymmetrical lobar involvement
Appearance of PTC in HT glands
Dr Ahmed Esawy
-
Infiltrating PTC in CLT (Hashimotos)
Microcalcifications throughout the right lobe without a focal mass
Dr Ahmed Esawy
-
59-year-old woman (a false-negative). A and B, Transverse and longitudinal sonographic images of the thyroid show fine isoechogenicity, a normal range for the AP diameter, and the presence of a smooth margin. Pathology results showed a papillary thyroid carcinoma in the left lobe and chronic lymphocytic thyroiditis after thyroid surgery.
Dr Ahmed Esawy
-
DTD of the thyroid in a 33-year-old woman. Transverse and longitudinal sonographic images of the thyroid show mild hypoechogenicity, coarse echogenicity, mildly increased vascularity, and the presence of a microlobulated margin. Pathology results showed HT and a papillary thyroid carcinoma in the left lobe after thyroid surgery.
Dr Ahmed Esawy
-
Hashimotos with Unilateral Lateral Cervical Lymphadenopathy
Dr Ahmed Esawy
-
increased incidence of thyroid malignancy in Hashimoto thyroiditis. A strong association is identified between thyroid non-Hodgkin lymphoma and antecedent Hashimoto thyroiditis.
Dr Ahmed Esawy
-
Hashitoxicosis
Dr Ahmed Esawy
-
Graves disease / Hashimotos thyroiditis
Thyroid inferno Graves disease: 4 hour uptake of 40% Dr Ahmed Esawy
-
Thyroid parenchyma echogenicity follows: grade 1 normal, echogenicity similar to the one of the prethyroid musculature; grade 2 hypoechoic in relation to the submandibular gland and hyperechoic in relation to the prethyroid musculature; grade 3 iso- or hypoechoic in relation to the prethyroid musculature grade 4 thyroid gland with increased volume and diffuse and marked parenchyma hypoechogenicity
Value of thyroid echogenicity in the diagnosis of chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Longitudinal view of left thyroid lobe. Bmode US demonstrates micronodular texture and hypoechoic aspect of the thyroid parenchyma. The echogenicity level of the thyroid gland is lower than that of the adjacent musculature.
Transversal view of left and right thyroid lobes. B-mode US demonstrates typical aspect of thyroid parenchyma echogenicity. The echogenicity level of the thyroid gland is higher than that of the adjacent musculature.
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Longitudinal views of thyroid lobe. Mode-B US demonstrates a diffusely heterogeneous texture of the thyroid parenchyma with no nodule (A). Amplitude color Doppler demonstrates a diffusely increased vascularization of the gland (B).
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Longitudinal views of thyroid lobe. Mode-B US demonstrates a diffusely heterogeneous texture of the thyroid parenchyma intermingled with areas of lower echogenicity (pseudonodules), where true nodules are not characterized (A). Amplitude color Doppler demonstrates increased vascularization of the thyroid gland; and nodules are not delimited (B).
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Longitudinal views of thyroid lobe. Mode-B US demonstrates a diffusely heterogeneous texture of the thyroid parenchyma intermingled with areas of lower echogenicity where true nodules are not characterized (A). Amplitude color Doppler demonstrates increased vascularization of the thyroid gland (B).
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
B-mode US demonstrates chronic autoimmune thyroiditis with goiter: hypoechogenic and heterogeneous thyroid gland increase in volume (A,B,C). Presence of hyperechogenic pattern of fibrosis (A,B) and lobulated margins (C).
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Atrophic presentation of chronic autoimmune thyroiditis with heterogeneous and hypoechogenic thyroid gland presenting with decrease in volume
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
At left, computed histogram in a longitudinal view of the thyroid parenchyma, and at left, in a transverse view of the sternocleidomastoid muscle (1),prethyroid musculature (2) and subcutaneous fat tissue (3). One can observe that the mean value of the thyroid parenchyma echogenicity is lower than that of the adjacent muscles, configuring the hypoechogenic pattern of chronic autoimmune thyroiditis
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
At left, computed histogram in a transverse view of the left thyroid lobe, and at right, in a transverse view of the sternocleidomastoid muscle (1),prethyroid muscle (2) and subcutaneous fat tissue (3). One can observe that the mean value of the thyroid parenchyma echogenicity is lower than that of the adjacent muscles, configuring the hypoechogenic pattern of chronic autoimmune thyroiditis.
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
At left, computed histogram in a transverse view of the left thyroid lobe, and at right, in a transverse view of the sternocleidomastoid muscle (1),prethyroid muscle (2) and subcutaneous fat tissue (3). One can observe that the mean value of the thyroid parenchyma ( ROI 1 at left) echogenicity is higher than that of the prethyroid and sternocleidomastoid muscles (ROI 1 and 2 at right), configuring the normal echogenicity pattern of the thyroid.
chronic autoimmune thyroiditis
Dr Ahmed Esawy
-
Subacute Thyroiditis
Subacute granulomatous thyroiditis (nonsuppurative thyroiditis, subacute thyroiditis, or de Quervain thyroiditis)
Dr Ahmed Esawy
-
A number of inflammatory conditions can affect the thyroid gland, which are commonly described as thyroiditis : subacute thyroiditis
granulomatous: de Quervain thyroiditis: subacute granulomatous thyroiditis Lymphocytic (autoimmune ) : subacute lymphocytic thyroiditis: silent thyroiditis or painless subacute thyroiditis
postpartum thyroiditis: is a subtype of silent thyroiditis
Dr Ahmed Esawy
https://radiopaedia.org/articles/thyroid-glandhttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/subacute-granulomatous-thyroiditishttps://radiopaedia.org/articles/autoimmune-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/missing?article[title]=sub-acute-lymphocytic-thyroiditishttps://radiopaedia.org/articles/post-partum-thyroiditis
-
Subacute Thyroiditis
Subacute thyroiditis usually presents with a transient hyperthyroidism followed by hypothyroidism
The lymphocytic kind, which is silent thyroiditis [has an unknown pathogenesis or is autoimmune]
the granulomatous kind, which is painful [and typically has a viral etiology]. de Quervain thyroiditis
Dr Ahmed Esawy
https://radiopaedia.org/articles/de-quervain-thyroiditishttps://radiopaedia.org/articles/de-quervain-thyroiditis
-
Subacute granulomatous (De Querveins)thyroiditis Clinical Signs
Usually viral
Diffuse enlargement
Tenderness / mild to severe pain
Transient hyperthyroidism
Gradual or fairly abrupt onset
Dr Ahmed Esawy
-
Subacute (De Querveins) thyroiditis
The inflammation do not involve entire gland but infiltrates gland in non-homogenous pattern
Sonographic feature (hypoechoic and hyper vascular areas)
Dr Ahmed Esawy
-
acute phase 1-focal,ill-defined, hypoechoic nodular area in the subcapsular region 2-normal or heterogeneous, hypoechoic adjacent thyroid parenchyma. 3-nodular area is avascular or hypovascular on Doppler ultrasound 4-Tenderness of the thyroid is elicited by transducer pressure 5-Inflammatory nodes are often seen in the central compartment or the lower internal jugular chain.
Dr Ahmed Esawy
-
Transverse power Doppler ultrasound shows a focal, ill-defined, avascular, hypoechoic nodular area in the subcapsular region (arrow) in the acute phase of de Quervain thyroiditis
Dr Ahmed Esawy
-
subacute phase
1-progression of glandular enlargement to involve the whole lobe or even the entire gland 2-Hypovascular 3-diffuse patchy or confluent, ill-defined hypoechoic echo pattern. 4-residual tenderness on transducer pressure. 5-Adjacent inflammatory nodes may still be seen
Dr Ahmed Esawy
-
Subacute Thyroiditis-DeQuervains
0.16 to 0.36% of thyroid disease Usually a viral infection Usually an adult female with thyroid tenderness, systemic systems May have thyrotoxicosis or be euthyroid Hypoechoic patchy or nodular areas that resolve Variable vascularity Maybe highly vascular and simulate Graves Disease
Dr Ahmed Esawy
-
Longitudinal grey scale ultrasound shows that in the subacute phase of de Quervain thyroiditis there is progression to involve almost the entire lobe (arrows).
Dr Ahmed Esawy
-
recovery atrophic phase return to normal appearance Occasionally glandular atrophy residual nodule may be seen
Dr Ahmed Esawy
-
Subacute Thyroiditis
43 yo female patient with a swollen and painful thyroid
One year later
Dr Ahmed Esawy
-
Subacute Thyroiditis
30/M
Hyperthyroid symptoms
131I thyroid scan
Thyroid not visualized
Only background radioactivity
Dr Ahmed Esawy
-
Iodine-131 radionuclide scan shows virtually no uptake of radioactive iodine by the thyroid gland.
Dr Ahmed Esawy
-
TUS image of subacute thyroiditis in the hyperthyroid phase (FT3: 10.7 pmol/l, FT4: 33.1 pmol/l, TSH: 0.039 mIU/l, antibodies negative). Note the low perfusion as shown by the Doppler imaging (right).
Dr Ahmed Esawy
-
thyroidectomy
Absent thyroid gland in a patient after total thyroidectomy due to papillary thyroid carcinoma. Note fibrous tissue without residual thyroid parenchyma in the thyroid beds.
Dr Ahmed Esawy
-
Atrophic Thyroiditis
Autoimmune thyroid disease Small and atrophic gland Maybe hypoechoic or normal echogenicity Normal of low uptake on I-123 scan Dr Ahmed Esawy
-
atrophic thyroiditis
TUS of atrophic thyroiditis (a patient with mild hypothyroidism: TSH 9.43 mIU/l, highly positive anti-TPO antibodies).
Dr Ahmed Esawy
-
Post partum
TUS of the left thyroid lobe of patient with PPT which occurred two months after delivery . Four months after delivery, the patient developed hypothyroidism
Dr Ahmed Esawy
-
euthyroid thyriod Enlarged thyroid
No functional disturbance
Dr Ahmed Esawy
-
euthyroid woman
TUS image in a young euthyroid woman with negative antithyroid antibodies
Dr Ahmed Esawy
-
TUS of a diffuse goitre in a euthyroid patient
Dr Ahmed Esawy
-
Normal TUS image of left thyroid lobe (euthyroid patient with negative thyroid autoantibodies). Note the low perfusion on the Doppler imaging (right).
Dr Ahmed Esawy
-
amyloidosis
TUS image of thyroid amyloidosis confirmed by cytology
Dr Ahmed Esawy
-
Langerhans cell histiocytosis
in the thyroid may manifest as goitre and precede subsequent multisystem involvement
Diffuse or nodular hypoechoic goitre with heterogeneity heterogeneous thyroid enlargement with anterior prominent projections FNAC confirming the diagnosis.
Dr Ahmed Esawy
-
multifocal, ill-defined,heterogeneous hypoechoic lesions involving both lobes of the Thyroid solitary well-defined, heterogeneous, predominantly anechoic lesion with internal echoes and irregular margins/walls
Thyroid tuberculosis
Dr Ahmed Esawy
-
Malignant diffuse thyroid disease
Dr Ahmed Esawy
-
Accounts for 0.8% to 5.3% of PTC Patients present with a diffuse goiter Mostly are euthyroid (hypothyroid or hyperthyroid) Most frequently in young females Mistaken for thyroiditis Lymph node and lung metastases are common Similar cure rates c/w classic PTC
Diffuse Sclerosing Variant of Papillary Thyroid Cancer
Dr Ahmed Esawy
-
Scattered Calcifications
Psammoma Bodies
Diffuse Sclerosing Variant of Papillary Thyroid Cancer Dr Ahmed Esawy
-
anaplastic carcinoma
rapidly growing, large (usually >5 cm), painful thyroid-area mass symptoms from local invasion/compression to the upper aerodigestive tract, such as dyspnoea, dysphagia and hoarseness
Dr Ahmed Esawy
-
Ill defined hypoechoic tumour diffusely infiltrating the entire lobe or gland Necrotic areas and dense amorphous calcifications are common Background of nodular goitre is seen in 47%. Extracapsular spread to invade the adjacent structures is seen in a third of the patients Nodal or distant metastases are present in 80% of patients The metastatic nodes are hypoechoic and show cystic necrosis in 50% of cases Doppler ultrasound shows multiple, small, chaotic intratumoral vascularity necrotic tumours may be avascular or hypovascular due to vascular infiltration/occlusion Abnormal vascularity is also seen within the metastatic nodes tumour thrombus in the infiltrated vessels.
Sonographic features
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows an anaplastic carcinoma of thyroid as an ill-defined hypoechoic tumour diffusely infiltrating the entire gland (arrows). Note the dense amorphous calcifications (curved arrows).
Dr Ahmed Esawy
-
Transverse grey s cale ultrasound of shows an enlarged, roundish, hypoechoic nodal metastasis (arrows) with cystic necrosis (curved arrow) from the anaplastic carcinoma.
Dr Ahmed Esawy
-
Thyroid metastases
haematogenous spread, such as malignant melanoma (39% of cases), renal (10% of cases), breast (21% of cases)54 and lung carcinomas. Pancreatic and gastrointestinal malignancies
Dr Ahmed Esawy
-
Sonographic findings
ill-defined, heterogeneous hypoechoic lesions May be relatively circumscribed, iso- or hypo-echoic, and show cystic/necrotic components. They are often multiple, unilateral or bilateral. The absence of microcalcification is useful to distinguish from primary papillary carcinoma of thyroid Ultrasound guided fine needle aspiration was shown to provide diagnostic
Dr Ahmed Esawy
-
Longitudinal power Doppler ultrasound shows a thyroid metastasis as an ill-defined, heterogeneous hypoechoic lesion (arrows). Note the scanty vasculrity. Patients with thyroid metastases often have extensive metastatic disease in the rest of the body and thus a poor prognosis.
the primary bronchogenic carcinoma in the medial aspect of the lower lobe of the right lung) *).
Dr Ahmed Esawy
-
Chronic lymphocytic leukaemia /small lymphocytic lymphoma
Dr Ahmed Esawy
-
CLL/SLL 2 to 5% of all thyroid malignancies Nodular pattern Homogeneously hypoechoic with lobulated but well defined border; enhanced though transmission Diffuse disease- asymmetric enlargement, heterogeneous,hypoechoic goitre Mixed pattern . hypoechoic,enlarged neck nodes with loss of normal architecture and abnormal increased vasculature on Doppler
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows a heterogeneous, hypoechoic goitre of the right lobe of thyroid (arrows). Adjacent abnornal right jugular chain lymph node with loss of normal architecture (curved arrow) is present. Biopsy revealed leukaemia.
Dr Ahmed Esawy
-
Transverse grey scale ultrasound shows a diffuse goitre with heterogeneous, hypoechoic echo pattern (arrows). An enlarged pre-tracheal node with loss of normal architecture is present (curved arrow). Biopsy revealed lymphoma.
Dr Ahmed Esawy
-
Transverse power Doppler ultrasound shows an ill-defined,heterogeneous hypoechoic lesion (arrows) involving most of the right lobe of thyroid. Increased vascularity, mainly peripheral, is demonstrated. Biopsy showed thyroid lymphoma
Dr Ahmed Esawy
-
Longitudinal power Doppler ultrasound shows an enlarged, elliptical, hypoechoic lymph node (arrows) with loss of normal architecture and abnormal increased peripheral vascularity
Dr Ahmed Esawy
-
Thyroid Lymphoma
Small and atrophic right lobe
Enlarged and hypoechoic left lobe
Dr Ahmed Esawy
-
Enlarged left lobe Hypoechoic, lobulated lesion Good through transmission
Thyroid Lymphoma
Dr Ahmed Esawy
-
May have patchy irregular areas that are pseudo-nodules Tend to be small (under 15 mm), hyperechoic and non-calcified Larger lesions or those with irregular margins raise concern for a neoplasm Focal calcifications and asymmetric calcifications should be considered suspect for papillary carcinoma
Dilemma: Nodules in patients with Diffuse Thyroid Disease
Dr Ahmed Esawy
-
Sonogram of the left lobe of the thyroid gland in the transverse plane showing a rounded lobe of a goiter. L=enlarged lobe, I= widened isthmus, T=trachea, C=carotid artery ( note the enhanced echoes deep to the fluid-filled blood vessel), J=jugular vein, S=Sternocleidomastoid muscle, m=strap muscles,E=esophagus.
Dr Ahmed Esawy
-
Quantitative analysis of echogenicity for patients with
thyroid nodules
Dr Ahmed Esawy
-
The coordinates of three defined regions, the nodule, thyroid parenchyma, and strap muscle regions
Dr Ahmed Esawy
-
gray values inside the selected regions of the nodule = nodule gray values inside the thyriod = thyroid gray values inside the muscle = muscle
nodule can be classified as hypoechogenicity when nodule is smaller than thyroid marked hypoechogenicity when nodule is smaller than muscle
differences between nodule and muscle and between nodule and thyroid were recorded to represent the adjusted EI of the nodule and were denoted as EIN-M and EIN-T
Dr Ahmed Esawy
-
Autonomic references was calculated using the software
Dr Ahmed Esawy
-
where GRij is the gray value of the pixel (i, j), and L is the average of the non-zero gray values of all pixels in the anterior region
The average gray value of the outside reference (ref) was then calculated as follows
Finally, the automatic EI was obtained by
Dr Ahmed Esawy
-
Analysis of EIs of Benign and Malignant Thyroid Nodules
Dr Ahmed Esawy
-
echogenicity index (EIN-M and automatic EI (EI(N-R)/R) values for lesions
Dr Ahmed Esawy