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USG THYROID PPT 1

This document discusses ultrasound imaging of the thyroid gland. It provides normal thyroid measurements and appearance. Thyroid disease is divided into thyroid nodules, diffuse thyroid disease, and thyroid cancer. Thyroid nodules are evaluated using the TI-RADS system, which assigns a risk level based on features such as composition, echogenicity, margin, echogenic foci, and size. Diffuse diseases discussed include acute suppurative thyroiditis, Hashimoto's thyroiditis, Graves' disease, and Riedel's thyroiditis. Benign and malignant nodules can be distinguished based on characteristics such as composition, calcifications, vascularity, and lymph node involvement.

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Jahanavi Jalu
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378 views42 pages

USG THYROID PPT 1

This document discusses ultrasound imaging of the thyroid gland. It provides normal thyroid measurements and appearance. Thyroid disease is divided into thyroid nodules, diffuse thyroid disease, and thyroid cancer. Thyroid nodules are evaluated using the TI-RADS system, which assigns a risk level based on features such as composition, echogenicity, margin, echogenic foci, and size. Diffuse diseases discussed include acute suppurative thyroiditis, Hashimoto's thyroiditis, Graves' disease, and Riedel's thyroiditis. Benign and malignant nodules can be distinguished based on characteristics such as composition, calcifications, vascularity, and lymph node involvement.

Uploaded by

Jahanavi Jalu
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© © All Rights Reserved
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USG THYROID

BY DR. RONAK SAVANI


• At USG, normal thyroid tissue appears
homogeneously echogenic with a
uniform homogeneous echotexture.
echogenicity – less than adj. subcut. Fat and more than muscle

The thyroid lobes size -- 1.3–1.8 cm in AP and T and 4–6 cm in length

Isthmus -- AP thickness of up to 3 mm
• Thyroid disease--- for imaging divide into 3 sections.

• 1. Thyroid nodules or focal lesions.


• 2. Diffuse thyroid disease
• 3. Thyroid CA
1. Thyroid nodules
• USE TIRADS--------Thyroid imaging reporting and data system (TIRADS)
which to categorize thyroid nodules and stratify
their malignant risk.

Points in five feature categories are summed to determine a


risk level from TR1 to TR5.
Recommendations for biopsy or US follow-up are based on
the nodule’s ACR TI-RADS level and its maximum diameter.
EXAMPLES:
SOLID CYSTIC ----- 1 Point
Solid ----2 point
Either completely solid or
have small cystic parts which are less than 50 % of total nodule ( in
spongiform nodule – cystic part more than 50 %)
2nd parameter---Echogenicity
Hypoechoic--- means that a lesion is more hypoechoic than normal thyroid parenchyma .
A very hypoechoic lesion – means is more hypoechoic than normal muscle
4th point - Margin
th
5 point - more than 1 mm
2 point – irrespective of complete or incomplete
rim calcification
Punctate echogenic foci are also knows as microcalcifications. They are a strong predictor
of malignancy and therefore get 3 points.
Also, because in the normal thyroid there also may be echogenic foci visible. So, 3 points
they are obvious and only visible within the nodule.

2nd image -Small comet tail artifacts with a length less than 1mm are also included in this
category.
• Growth of a nodule and follow up –
• ≥20% increase in at least two nodule dimensions, with a minimal
increase of 2 mm or
• ≥50% or greater increase in volume.

• If there is no change in size for 5 years, the nodule can be considered as


having a benign behavior, and further follow up is not needed.
• If there is interval growth without fulfillment of FNA criteria, the next
follow-up should be after 1 year, regardless of the TI-RADS category.

• For multiple nodule –


• When there are multiple nodules, there should be no more than 4
nodules classified.
Part 2--- Diffuse thyroid involvement
1. Acute suppurative– ill defined, hypoechoic, heterogenous.
Internal debris , speta +-, LN
• 2. Subacute granulomatous thyroiditis – De
Quervain thyroiditis

• Non suppurative, uncommon.


• More in women – 2nd to 5th decade
• Present with thyroid tendeness, fever
• self limiting.
• On USG- poorly defined regions of reduced echogenicity with reduced or
no vascularity
• U/L or B/L.
3. Hashimoto thyroiditis (chronic autoimmune
lymphocytic)
• Most common form
• More in women
• non specific enlargement of gland without calcification or necrosis.
• In Early stage –Non specific. Enlarged and diffuse heterogenous
hypoechoic echotexture with hypoechoic micronodules (1-6 mm)
With normal or decrease vascularity
• In late stage – small hypoechoic heterogenous fibrotic gland with NO
blood flow on colour Doppler
• It can be localized form of hashimoto disease
Early late form
Graves disease
• Hyper functioning thyroid
• On USG – inhomogenous diffusely hypoechoic gland and enlarged
gland with
Hypervascular on colour Doppler - Thyroid inferno patter
Increased PSV 10-15 folds
(normal – in inferior thyroid A – 10-15 cm /sec and in
parenchymal vessel – 3-5 cm/sec)
Reidel’s thyroiditis
• Invasive fibrous thyroiditis.
• On USG- thyroid appear homogenously hypoechoic with poor
demarcation of gland border as fibrotic invasion of
adjacent fat or anatomical structure.
GOITER

1.Simple diffuse goiter –On USG – moderately to


marked enlarged thyroid with normal homogenous
echogenicity
• 2. Multinodular Goiter
• Gland enlarged and also well marginated
• On USG – focal or diffuse replacement of thyoroid parenchyma by diffuse
inhomogenous echogenicity or multiple focal hypoechoid nodules.
• Calcifications, necrosis, cystic degeneration and haemorrhage may be seen.
BENIGN VS MALIGNANT
1. Papillary CA
• On USG – hypoechoic lesion
• Microcalcification – fine punctate
• Hypervascular
• Low grade
• LN metastasis
Cystic variant of papillary CT- atypical form
2. Follicular CA
• On USG – hypoechoic ill defined lesion with
THICK IRREGULAR capsule

• Type –
• Minimally invasive – Encapsulated.
• Invasive –not well capsulated with vascular
Invasion.
3. Medullary CA
• Multicentric
• Arise from parafollcular C cells
• On USG – hypoechoic solid nodule with
• Coarse internal calcifications
• Involved LN ---typically calcify
4. Anaplastic CA
• Fatal CA
• Elderly women, long standing goiter
• On USG – hypoechoic lesion encasing
The vessels.
Primary lymphoma
• Old age female.
• Hashimotos diease
• Nodular or diffuse
• On USG – enlarged thyroid gland is
Replaced by heterogeneous mass with
hypoechogenicity.
No significant vascularity / calcification.
Multiple LN
THANK YOU

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