Thyroid Protocol

Structur Scan Label Landmarks

e Plane
Transvers ISTHMUS Isthmus
Isthmus
e RT lobe of thyroid
with
Left lobe of thyroid
RT and
Longus coli
LT
o Use virtual convex or dual screen mode if
Lobes
necessary
Transvers ISTHMUS Isthmus with clear anterior and posterior borders
Isthmus
e ISTHMUS Isthmus with AP measurement
Transvers RT LOBE TX SUP RT lobe thyroid superior
e RT LOBE TX MID RT lobe thyroid mid
RT LOBE TX MID RT lobe thyroid mid with width measurement
RT LOBE TX MID RT lobe thyroid mid with color Doppler
RT LOBE TX INF RT lobe thyroid inferior
Sagittal RT NECK SAG Neck Muscles
RT
o Document any abnormal lymph nodes seen
Lobe/
RT LOBE SAG LAT RT lobe thyroid lateral
Neck
RT LOBE SAG MID RT lobe thyroid mid
RT LOBE SAG MID RT lobe thyroid mid with length and AP
measurements
o Use virtual convex or dual screen mode if
necessary
RT LOBE SAG RT lobe thyroid medial
MEDIAL
LT LOBE TX SUP LT lobe thyroid superior
LT LOBE TX MID LT lobe thyroid mid
Transvers
LT LOBE TX MID LT lobe thyroid mid with width measurement
e
LT LOBE TX MID LT lobe thyroid mid with color Doppler
LT LOBE TX INF LT lobe thyroid inferior
LT NECK SAG Neck Muscles
o Document any abnormal lymph nodes seen
Lt Lobe/
LT LOBE SAG LAT LT lobe thyroid lateral
Neck
LT LOBE SAG MID LT lobe thyroid mid
LT LOBE SAG MID LT lobe thyroid mid with length and AP
Sagittal
measurements
o Use virtual convex or dual screen mode if
necessary
LT LOBE SAG LT lobe thyroid medial
MEDIAL

Anatomical/Image Correlation- www.steadyhealth.com/.../4540/Image/thyroid1.jpg

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 Thyroid Protocol

Mi
d

Superi
orMi Medi
d
Inferio al
r Later
al
Transverse Sagittal
Normal Measurement
Images Images Images
Ranges

Structure Area of Plane Measureme Comments

Interest nt
Isthmus Isthmus Transver 4-6 mm Measure anterior to posterior
midline se
Lobes Length Sagittal 4-6 cm Mid portion measure superior to
inferior
*Use virtual convex or dual screen
when applicable
Height (A/P Sagittal .5-2cm Mid portion measure anterior to
thickness) posterior
*Some physicians may want this
measurement in the transverse
plane
(Clarify before exam)
Width Transver 2-4 cm Mid portion measure medial to
se lateral

Tips -You should understand completely why you stored the image and identify everything in the image

You must always evaluate the entire organ first before you store an image
Make sure you look lateral to the thyroid for pathology
Make sure you look above and below the thyroid for pathology
You are looking for enlarged lymph nodes or parathyroid glands
Normal lymph nodes are elliptical/ bean-shaped and have a hypoechoic cortex with an
echogenic hilum
Normal parathyroid glands are not visualized sonographically
Document what you see - this is EXTREMELY IMPORTANT!!!

Labs to Evaluate
TSH (thyroid stimulating hormone)- used to identify thyroid disease
T4 (thyroxine)- reflects thyroid hormone activity
T3 (Triiodothyronine)- provides information regarding function of the thyroid

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Pathology - If pathology is present you must document the pathology in its entirety. Images should
include:
Gray scale sagittal and transverse images
Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
Color Doppler image to document the presence of blood flow and spectral Doppler image to
document the type and velocity of blood flow

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