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