What is a thyroid ultrasound?

The thyroid ultrasound is a noninvasive ultrasound-based imaging scan that provides structural or morphological details of the thyroid gland.

Thyroid gland scan information refers to:

The position and dimensions of the thyroid lobes and the isthmus that connects them, respectively their volume.

The appearance of the tissue contained in the thyroid lobes and the possible pathological presence of nodules and/or cysts.

Blood circulation throughout the thyroid tissue.

The relationship of the thyroid with the organs in its immediate vicinity (trachea, oesophagus, blood vessels).

Examination of the entire anterior cervical region including the laterocervical ganglion chains, large vessels of the neck, parathyroid tumors, extrathyroid tumors.

Patients of all ages (children, pregnant women, nursing women, the elderly) can benefit from this non-radiant and painless ultrasound that does not require prior training.

It can be repeated as many times as necessary, on the recommendation of the doctor.

High-resolution ultrasound is the first-line imaging method in thyroid exploration, being considered the most sensitive method of investigating this gland and also the most accessible.

It is performed with the patient lying on their back with their face up and by positioning a thin pillow under their shoulders to facilitate the extension of the neck and thus the display of the thyroid gland (necessary especially for obese people or those with shorter necks).

Endocrinologists follow a protocol for examining the thyroid as follows:

  • transverse scan (in the horizontal plane) and measurement of two diameters for each thyroid lobe and separately for the isthmus;
  • longitudinal scan (vertical plane) with measurement of the maximum craniocaudal diameter of each thyroid lobe;
  • identification of focused lesions and their ultrasound characterization;
  • color Doppler examination of both the global thyroid parenchyma and the individual focused lesions;
  • identification of extrathyroid pathological formations and laterocervical lymphadenopathy.

The thyroid ultrasound is the most sensitive and effective method of anatomical evaluation of the thyroid. The superficial location of the soft tissues in the anterior region of the neck allows a very good visualization of the thyroid, the detection of anatomical variations and the identification of extrathyroid formations.

Normally, the thyroid gland is located in the anterior cervical region, with the two thyroid lobes being on either side of the trachea. The lobes are joined at the median level by the thyroid isthmus located on a prominent cartilage of the trachea (called cricoid cartilage). The thyroid lobes have an oval shape in the vertical plane with the upper pole longer and the lower one more rounded. In one of three normal individuals, an additional lobe called a pyramid can be identified and located on the midline.

The normal dimensions of the thyroid gland are: the longitudinal diameter of each lobe less than or equal to 4 cm, and the anteroposterior and transverse diameters each less than or equal to 2 cm. We diagnose goiter or thyroid hypertrophy in patients with diameters larger than those mentioned above.

In selected pathological cases, the imaging exploration of the thyroid will be completed with computer tomography of the cervical and thoracic region, nuclear magnetic resonance, respectively thyroid scintigraphy, which is performed in specialized radiology centers.

When is a thyroid ultrasound recommended?

There are many situations in which thyroid ultrasound is recommended:

  • When a person in a family is diagnosed with thyroid cancer regardless of type/stage, this person’s close relatives are required to perform a thyroid ultrasound, but also specific thyroid tests, being considered at high risk of developing thyroid cancer.
  • Also, patients with a history of oncology and who have undergone therapeutic irradiation at the cervical or cranial level are considered at high risk of developing thyroid cancer and will benefit from ultrasound screening of the thyroid lodge.
  • When the patient notices a deformity of the base of the neck, possibly swelling at this level, which can be felt by the patient on self-palpation or noticed by their entourage and which often corresponds to a thyroid nodular formation.
  • When the patient complains of symptoms at the base of the neck, the causal link with the thyroid must be proven through symptoms such as difficulty swallowing (dysphagia) or hoarseness (dysphonia) or constriction at the base of the neck accompanied by difficulty breathing (described as a sore throat).
  • Patients with palpable laterocervical lymphadenopathy and whose origin must be identified.
  • Symptoms suggestive of thyroid dysfunction with hypothyroidism: fatigue, weight gain with normal appetite, constipation, depression, bradycardia, hair loss and brittle nails, cold intolerance, menstrual disorders.
  • Symptoms suggestive of hyperthyroidism: palpitations, hot skin and sweating, nervousness, anxiety, fatigue, insomnia, diarrhea, tremor of the extremities, weight loss with increased appetite.
  • Follow-up of a thyroid disease, previously diagnosed, for which the patient is undergoing a specific treatment.
  • Postoperative follow-up of the thyroidectomy patient.

Being an easily accessible, repeatable, non-radiant and relatively inexpensive method, we recommend it in addition to a thyroid endocrinological consultation, being necessary for the confirmation/refutation of some clinical suspicions.

The benefits of a thyroid ultrasound

The information provided by the ultrasound will be correlated by the endocrinologist with the specific hormonal analyses and thus a correct and complete diagnosis will be formulated that will allow the recommendation of an adequate treatment.

Thyroid nodules represent a pathology in which the ultrasound provides information that is absolutely necessary for correct diagnostic and therapeutic decisions, information that cannot be obtained only through blood tests.

The significance of thyroid nodules differs depending on their size and ultrasound characteristics, the autoimmune field on which they evolve and the overall function of the thyroid, respectively the level of the thyroid tumor marker.

The prevalence of clinically intangible but ultrasound-detected nodules is high, being estimated at over 50% in people over 50, so that thyroid nodular pathology is therefore in half of cases an ultrasound discovery, often in an asymptomatic context.

Ultrasound accurately detects even 3-4 mm thyroid micronodules, and in the case of macronodules (nodules over 10 mm in diameter) allows them to be classified as suspected malignancy based on the following ultrasound characteristics: the appearance of the tissue inside the nodular formation, the presence microcalcifications, the aspect of the peripheral contour of the nodule, respectively the aspect of the circulation both inside and at the periphery of the nodule.

Ultrasounds of the thyroid lodge are required in the following situations:

For tracking small nodules less than 1 cm in diameter and with benign ultrasound characteristics, whether or not the patient is under treatment. The increase in size between two examinations, considered significant by the specialist and correlated with the blood tests, raises the suspicion of malignancy and recommends further investigations.

For a precise diagnosis of nodules over 1 cm in diameter and which associate ultrasound characteristics suspected of malignancy, the doctor will recommend PBAF = fine needle biopsy puncture which is performed in specialized services, in order to confirm / refute the suspicion of malignancy. If this suspicion is refuted, the patient will subsequently perform systematic ultrasound and hormonal checks, and if it is confirmed, they will be referred to an endocrinological surgery service.

For an indication of radical treatment (surgical or radioactive iodine) suitable for bulky nodules, possibly plunging into the mediastinum (whose lower edge we can not see with ultrasound, so we can not completely characterise the nodule / adjacent thyroid tissue through ultrasound) and which can present compressive phenomena on the surrounding organs.

Also in the clinical practice of chronic or subacute thyroiditis, an autoimmune or non-autoimmune ultrasound is required to confirm the diagnosis, establish the stage and form of the disease, as well as any local complications.

Chronic autoimmune thyroiditis or Hashimoto’s disease has two clinical forms that we best identify by ultrasound: goiter and atrophic.

In chronic autoimmune thyroid with goiter: the lymphocytic infiltrate characteristic of the disease and the destruction of thyroid tissue architecture causes a gland with increased volume of various degrees, associated with a decrease in echogenicity, resulting in heterogeneous hypoechoic appearance most often described in ultrasounds of patients with Hashimoto’s disease.

Benign or malignant nodules may coexist in these patients, requiring special monitoring.

The atrophic form of autoimmune disease shows on ultrasound a small gland with irregular edges and reduced overall thyroid tissue, typically containing hyperechoic fibrous bands.

Subacute thyroiditis (a form of Quervain’s thyroiditis) is viral in origin and often preceded by upper respiratory tract infections or other ENT infections. This form has exhibits noisier clinical manifestations than the chronic autoimmune form, patients being admitted with intense previous cervical pain, dysphagia (difficulty swallowing), low-grade fever, possibly headache and manifestations of hyperthyroidism which, to varying degrees, are found in the usual hormone doses. Initially, in subacute thyroiditis, an ultrasound shows diffuse or partial enlargement of the thyroid gland with hypoechoicity, which can be localized (at the level of a lobe or a portion of a lobe) or diffuse.

If the thyroid damage is focal, the ultrasound appearance is difficult to differentiate from nodular goiter. The evolution should be followed under specific anti-inflammatory treatment and ultrasound, in addition to hormonal supervision. A good evolution shows us the gradual return (within a few months) to the normal ultrasound aspect, and an unfavorable evolution can lead to the localization of the infection in the form of a thyroid abscess. Fortunately, this is a very rare complication.

Why perform a thyroid ultrasound at DigestMed?

At DigestMed you can perform high quality thyroid ultrasounds thanks to the latest generation Arieta ultrasound equipment using a 14 Mhz high resolution probe.

The clinical integration of the information thus obtained will be made by our specialists who will explain the diagnosis, the treatment possibilities and the necessary follow-up.

Why DigestMed?

DigestMed medical team

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