Benign Conditions of the Thyroid Gland

Amy Fan-Yee Juliano, MD

Mary Beth Cunnane, MD

Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical

School, Boston, MA

Infectious and autoimmune diseases account for the majority of benign conditions of the thyroid
gland. They are usually diagnosed and followed by clinical examination and laboratory analyses,
but when imaged, ultrasonography and computed tomography are the modalities of choice. In
particular, fine needle aspiration under ultrasound guidance may be invaluable for diagnostic and
therapeutic purposes.

Figures and tables from this article:

Figure 1. Acute suppurative thyroiditis. (A) Transverse color-Doppler ultrasonography

(US) image of the left upper pole. The parenchyma is hypoechoic and edematous with
mild increased vascularity. In the posteromedial aspect is an abscess (arrow). (B) Axial
contrast-enhanced computed tomography (CT) demonstrates a diffusely enlarged gland
with areas of heterogeneous hypodensity. Note blurring of surrounding fat and edematous
appearance of adjacent structures from secondary inflammatory involvement. (C) Axial
postcontrast T1-weighted magnetic resonance image shows enhancing inflammatory
tissue and an abscess (arrow). (Color version of figure is available online.)
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Figure 2. Acute suppurative thyroiditis related to a pyriform sinus fistula. Contrastenhanced CT image (A) shows edema and heterogeneously enhancing inflammatory soft
tissue in the left postcricoid pharynx. Barium swallow (B) demonstrates a pyriform sinus
fistula (arrow).
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Figure 3. Subacute thyroiditis. Noncontrast-enhanced CT image demonstrates a diffusely

enlarged thyroid gland with hypodense areas.
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Figure 4. Graves disease. Sagittal gray-scale image (A) of the thyroid gland demonstrates
mild inhomogeneity. Sagittal color-Doppler image (B) demonstrates diffusely increased
vascularity throughout the thyroid parenchyma, the so-called thyroid inferno. (Color
version of figure is available online.)
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Figure 5. Hashimoto thyroiditis. Sagittal US image (A) demonstrates a mildly enlarged

gland with a few irregular hypoechoic areas with echogenic rims (arrows) seen in the
early stage. In the advanced stage (B), the gland is coarse in echotexture, multinodular,
and is predominantly hypoechoic.
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Figure 6. Hashimoto thyroiditis and lymphoma. Axial contrast-enhanced CT image

demonstrates an enlarged and heterogeneously hypodense thyroid gland. However, the
posterior aspect is even more hypodense, and extends as exophytic soft tissue posterior to
the trachea (between arrows), inseparable from the esophagus (arrowhead). This area is
involved by lymphoma.
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Figure 7. Goiter. Coronal (A) and axial (B) images through the neck demonstrate an
enlarged heterogeneously enhancing mass, which is contiguous with the left lobe of the
thyroid and extends substernally into the mediastinum (arrows). There is mass effect on
the trachea, without compression.
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Figure 8. Intrathyroidal ectopic thymus. Sagittal US image shows a well-defined

hypoechoic nodule, which on biopsy proved to be ectopic thymic tissue.
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Address reprint requests to Amy Fan-Yee Juliano, MD, Department of Radiology,
Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114
Copyright 2012 Elsevier Inc. All rights reserved.