THYR0l0

MARY AN1OINE11E BRIONES-

MAOBANLA.MD
LEVEL III \VSL-Mt
ltSTRuHFtTATl0t At0 TFCHtl0uF
Hih-lrcqucncv |ransduccrs (7.5 -15 Mhzi
Lincar arrav |ransduccrs wi|h ci|hcr rcc|anular or
|rapczoidal scan lorma| arc prclcrrcd bccausc ol |hc widcr
ncar licld ol vicw and |hc capabili|v |o combinc hih-
lrcqucncv rav-scalc and color Dopplcr imacr
Two ncwcr |cchniqucs:
Con|ras|-cnhanccd sonoraphv
Sonoclas|oraphv
ltSTRuHFtTATl0t At0 TFCHtl0uF
liure Iiu resoiutiou iiuear trausducer , MIz) |or
tue jer|ormauce o| turoid souoraju.
Tw0 tFwFR TFCHtl0uFS uSF0 F0R THF
S0t06RAPHlC STu0Y 0F THF THYR0l0 6lAt0
Con|ras|-cnhanccd sonoraphv
2
nd
-cncra|ion con|ras| acn|s arc uscd and vcrv low
mcchanical indcx can providc usclul inlorma|ion lor |hc
dianosis ol sclcc| cascs ol nodular discasc and lor u|z-
uidcd |hcrapcu|ic proccdurcs
Sonoclas|oraphv
Bascd on |hc principlc |ha| whcn bodv |issucs arc
comprcsscd, |hc sol|cr par|s dclorm morc casilv |han |hc
hardcr par|s
SO`Oll.S1OCK.lIY
las|oraphv is a ncwlv dcvclopcd dvnamic |cchniquc |ha| cmplovs
ul|rasound (ISi |o providc an cs|ima|ion ol |issuc s|illncss bv
mcasurin |hc dcrcc ol dis|or|ion undcr |hc applica|ion ol an
cx|crnal lorcc.
IS clas|oraphv has bccn applicd |o dillcrcn|ia|c malinan| lrom
bcnin lcsions.
las|oraphv imacs wcrc classilicd in|o 4 |vpcs:
Pa||crn 1, lih| rccn |hrouhou| |hc insidc ol |hc nodulc
Pa||crn 2, lih| rccn in |hc ccn|cr and bluc in |hc pcriphcrv
ol |hc nodulc;
Pa||crn `, bluc basc wi|h mixcd colors ol lih| rccn and rcd;
and
Pa||crn 4, bluc in |hc cn|irc nodulc.
SO`Oll.S1OCK.lIY
upillury thyroid cuncer imuget muinly thowed uttern s or 4, while lymph node
metuttutit tpecificully hud the imuget of uttern 4.
Folliculur thyroid cuncer thowed uttern z.
Adenomutout goiter thowed diffute light green {uttern t).
Figure 1: Proposed Clarification of Elastography for Thyroid
Tumors
ltSTRuHFtTATl0t At0 TFCHtl0uF
Thc pa|icn| is |vpicallv cxamincd in |hc supinc posi|ion wi|h
|hc ncck cx|cndcd
A small pad mav bc placcd undcr |hc shouldcrs |o providc
bc||cr cxposurc ol |hc ncck
Thc |hvroid land mus| bc cxamincd |horouhlv in bo|h
|ransvcrsc and loni|udinal plancs
Imain ol |hc lowcr polcs can bc cnhanccd bv askin |hc
pa|icn| |o swallow
Thc cn|irc land, includin |hc is|hmus, mus| bc cxamincd
ltSTRuHFtTATl0t At0 TFCHtl0uF
Staudardized S rejortiu criteria suouid be
|oiioved iudicatiu.
lositiou
Suaje
Size
Marius
Couteut
lcuoeuicit
Vascuiar jatteru o| tue vuoie iaud aud vueu
jreseut, tue |ocai iesious.
ltSTRuHFtTATl0t At0 TFCHtl0uF
liure ! 1uroid measuremeut ou trauserse ,.)
aud iouitudiuai ,l) scaus.
`OKM.l .`.1OMY
1ublc z Normul tl,roio oimcnsions
llOOl SlllY
1Il .K1lKIlS Ol 1Il 1IYKOIl .Kl.
Supcrior |hvroid ar|crv
W Ariscs lrom |hc cx|crnal caro|id ar|crv and dcsccnds
|owards |hc ipsila|cral |hvroid lobc. A| |hc uppcr polc
ol |hc land i| dividcs in|o |hc an|crior and pos|crior
divisions
Inlcrior |hvroid ar|crv
W Ariscs lrom |hc |hvroccrvical |runk and asccnds
alon |hc back ol |hc land |o rcach i|s pos|crior
surlacc
W Closclv rcla|cd |o |hc rccurrcn| larvncal ncrvc
l000 SuPPlY
Supcrior,middlc and inlcrior |hvroid vcins: oriina|c
lrom pcri|hvroid vcnous nc|work
Thc supcrior and middlc vcins drain in|o |hc
ipsila|cral IJV
Thc inlcrior |hvroid vcin rcccivcs |ribu|arics lrom |hc
is|hmus, |hcn anas|omoscs wi|h |hc inlcrior |hvroid
vcin lrom |hc opposi|c sidc and drains in|o |hc
brachioccphalic vcin
l000 SuPPlY
1uroidea ima arter.
Il prcscn|, ariscs lrom |hc aor|ic arch or |hc
brachioccphalic |runk and asccnds an|crior |o |hc
|rachca |o |hc is|hmus
lYHPHATlCS
LymphaLlc vessels from Lhe Lhyrold form a
subcapsular neLwork and glve rlse Lo laLeral and
medlal collecLlng Lrunks
1hese draln lnLo Lhe anLerlor and laLeral chaln of
nodes along Lhe l!v (deep cervlcal chaln) and Lhe
preLracheal and paraLracheal nodes
AtAT0HY
C0l0R At0/0R P0wFR 00PPlFR uS
Isclul |o cvalua|c |hc vasculari|v ol |hc |hvroid
land and local masscs
Thc |hvroid ar|crics mav bc localizcd on color or
powcr Dopplcr
A pcak svs|olic vcloci|v in |hc in|ra|hvroid ar|crics
is on |hc ranc ol 15-`0 cm/scc and is |hc vcloci|v
lound in anv supcrlicial oran
rLerlal vascularlzaLlon of Lhe Lhyrold gland
Cn color doppler Lhe lnferlor Lhyrold arLery
ls seen
C0t6FtlTAl At0HAllFS
Concni|al acncsia or hvpoplasia ol |hc |hvroid land mav
includc |hc wholc land or us| onc ol |hc lobcs.
c|opic |hvroid, a dclici| in mira|ion ol |hc |hvroid land |o
|hc lowcr ncck lrom i|s oriin a| |hc basc ol |hc |onuc,
dcvclops mos| commonlv a| a sublinual or a suprahvoid
posi|ion
c|opic |hvroid mav bc casilv dc|cc|cd on radionuclidc scans
Congen|ta| Deve|opmenta| Defects and C||n|ca| Cutcomes
Dcvclopmcn| ol |hc |hvroid land bcins a| |hc lirs|
and sccond wccks ol in|rau|crinc lilc and is complc|cd
bv wcck 11.
A and B. Thc |hvroid land ariscs as an cndodcrmal
|hickcnin a| |hc unc|ion ol |hc dcvclopin an|crior
and pos|crior |onuc, a| |hc lcvcl ol |hc loramcn
cccum, bc|wccn |hc lirs| and sccond branchial archcs.
Congen|ta| Deve|opmenta| Defects and C||n|ca| Cutcomes
C and D. Thc aor|ic sac ol |hc hcar|
dcsccnds and pulls |hc |hvroid
caudallv, i|s pharvncal conncc|ion
clona|cs as a s|alk, |hc |hvrolossal
duc|, which normallv disappcars bv
|hc lil|h |o six|h wcck ol in|rau|crinc
lilc.
Congen|ta| Deve|opmenta| Defects and
C||n|ca| Cutcomes
A |hvrolossal cvs|, lormin lrom a pcrsis|cn| |hvrolossal
duc|, appcars as a ncck lump a| |hc middlinc.
Thc normal placcd |hvroid land mus| bc scarchcd lor |o
cxcludc |hvroid acncsia.
In |hc abscncc ol a normal |hvroid, |hc cvs| will bc |hc
onlv prcscn| |hvroid |issuc.
THYR06l0SSAl CYST
,|d||ne neck |ump |n a 2 years o|d ma|e A A norma| thyro|d g|and at
the base of the neck |s present A cyst (cursors) |s seen ahead the
|sthmus of the g|and 8 1he cyst (arrow) |s demonstrated between the
thyro|d |sthmus and the hyo|d bone 1he submand|bu|ar sa||vary g|and
(SG) |s shown above the cyst 1hyro|d rad|onuc|ear scan was
performed preoperat|ve|y to conf|rm that the thyro|d g|and |s present
and norma||y funct|on|ng
HYPFRPlASlA At0 60lTFR
Arox|mote sO of nodu|or d|:eo:e |: cou:ed by
hyer|o:|o of the q|ond ond occur: |n u to s of
ou|ot|on
t|o|oq|e:: |od|ne def|c|ency (endem|c), d|:order:
hormonoqene:|: (hered|tory fom|||o| form:) ond oor
ut|||zot|on of |od|ne o: o re:u|t of med|cot|on
Co|ter - when hyer|o:|o |eod: to on ouero|| |ncreo:e
|n :|ze or uo|ume of the q|ond
HYPFRPlASlA At0 60lTFR
|:to|oq|co||y, |n|t|o| :toqe |: ce||u|or hyer|o:|o of the
thyro|d oc|n|, fo||owed by m|cronodu|e ond
mocronodu|e formot|on
yer|o:t|c nodu|e: - underqo ||quefoct|ue
deqenerot|on w|th the occumu|ot|on of b|ood, :erou:
f|u|d, ond co||o|d :ub:tonce --- referred to o:
hyer|o:t|c odenomotou:, or co||o|d nodu|e:
(otho|oq|co||y)
|n the cour:e of th|: cy:t|c deqenerot|ue roce::,
co|c|f|cot|on, wh|ch |: often cour:e ond er|nodu|or,
moy occur
HYPFRPlASlA At0 60lTFR
&|tro:ound feoture: of odenomotou: nodu|e:
|:oecho|c
yerecho|c becou:e of the numerou: |nterfoce:
between ce||: ond co||o|d :ub:tonce
yoecho|c :onqe||he or honeycomb ottern
vhen the nodu|e |: |:oecho|c or hyerecho|c, o th|n
er|hero| hyoecho|c ho|o |: ty|co||y :een ---
cou:ed by er|nodu|or b|ood ue::e|: ond m||d
edemo or comre::|on of the odjocent normo|
orenchymo
RLAIIlC {A0N0MAI00I)
N000L
Loni|udinal ul|rasound
imacs. A. Oval
homocncous nodulc
(arrowsi wi|h |hin, unilorm
halo. B. Thrcc
hvpcrcchoic nodulcs,
|vpical ol hvpcrplasia. C.
Soli|arv hvpcrcchoic
nodulc, which was bcnin
on INAB
,orpho|og|c patterns 41yearo|d man
w|th co||o|d nodu|e U|trasound scan
shows spong|form nodu|e S|m||ar|ty of
nodu|e to waterf|||ed sponge |s ev|dent
8en|gn nodu|es hyper or |so
echo|c to background
echotexture Cyst|c change |s
common
0F6FtFRATlvF CHAt6FS 0F
60lTR0uS t00ulFS
!ure|y onecho|c oreo: - cou:ed by :erou: or co||o|d
f|u|d
choqen|c f|u|d or mou|nq f|u|d-f|u|d |eue|: -
corre:ond: to hemorrhoqe
r|qht echoqen|c foc| w|th comet to|| ort|foct: - cou:ed
by m|crocry:to|: or oqqreqote: of co||o|d :ub:tonce ---
moy moue :|ow|y (||he :nowf|ohe:), w|th|n the f|u|d
co||ect|on
1h|n, |ntrocy:t|c :etot|on: --- robob|y corre:ond to
ottenuoted :trond: of thyro|d t|::ue ond com|ete|y
ouo:cu|or on co|or Do|er utz
0F6FtFRATlvF CHAt6FS 0F
60lTR0uS t00ulFS
1h|n, er|hero| eqq:he|| or coor:e, h|qh|y ref|ect|ue
foc| w|th o::oc|oted ocou:t|c :hodow:, :cottered
throuqhout the q|ond
Comet ta|| s|gn
ggshell CalclflcaLlon
0F6FtFRATlvF CHAt6FS 0F
60lTR0uS t00ulFS
|ntrocy:t|c :o||d roject|on:, or o|||oe, u:uo||y conto|n|nq
co|or Do|er :|qno|:, moy oeor to the rore cy:t|c
o|||ory thyro|d CA ---- :onoqrohy ond co|or Do|er
|moq|nq connot d|fferent|ote the :etot|on: of co||o|d
hyer|o:t|c nodu|e: from ueqetot|on: :een |n o|||ory CA
Contro:t-enhonced :onoqrohy w|th 2
nd
qenerot|on
m|crobubb|e: ond nond|:rut|ue |moq|nq con be u:ed
8eIg tepto --- do not :how enhoncement (ond
d|:oeor |n hormon|c mode)
oIIgot degeerotIet --- :how |nten:e enhoncement
|n the orter|o| ho:e w|th re|ot|ue|y fo:t wo:hout
C0tTRAST-FtHAtCF0 S0t06RAPHY T0 0lFFFRFtTlATF Ftl6t FR0H
HAll6tAtT Flul0-FlllF0 THYR0l0 t00ulFS wlTH ltTFRtAl
SFPTATl0tS 0R S0ll0 PR0JFCTl0tS
ConvenLlonal 8mode sonogram of
rlghL Lhyrold lobe demonsLraLes
large mlxed solld and cysLlc nodulep
1r Lracheal alr shadow C common
caroLld arLery ConLrasLenhanced
sonogram fLer admlnlsLraLlon of
conLrasL maLerlal Lhe lnLernal
conLenLs are no longer vlslble
because Lhey lack enhancemenL
lndlcaLlng LhaL Lhe conLenLs were
llkely collold and blood producLs C
ConvenLlonal 8mode sonogram ln
longlLudlnal plane demonsLraLes a
nodule (arrow) arlslng from Lhe
posLerlor wall u ConLrasLenhanced
longlLudlnal sonogram shows LhaL
Lhe nodule remalns vlslble lndlcaLlng
enhancemenL afLer conLrasL
ln[ecLlon 1he leslon was a cysLlc
paplllary C
A0Ft0HA
#ere:ent on|y s to IO of o|| nodu|or d|:eo:e of the thyro|d
q|ond
1x more common |n women thon |n men
Mo:t re:u|t |n no thyro|d dy:funct|on
A m|nor|ty (<IO) hyerfunct|on, deue|o outonomy ond moy
cou:e thyrotox|co:|:
Mo:t ore :o||tory, but moy o|:o deue|o o: ort of o
mu|t|nodu|or roce::
Ftl6t F0lllCulAR A0Ft0HA
A true thyro|d neo|o:m
Chorocter|zed by comre::|on of odjocent t|::ue: ond
f|brou: enco:u|ot|on
5ubtye:: feto| odenomo, urth|e ce|| odenomo, ond
embryono| odenomo --- d|:t|nqu|:hed occord|nq to the
tye of ce|| ro||ferot|on
Ftl6t F0lllCulAR A0Ft0HA
1he cyto|oq|c feoture: of fo|||cu|or odenomo ore
qenero||y |nd|:t|qu|:hob|e from tho:e of fo|||cu|or
corc|nomo
VA5C&A# AND CA!5&A# |NVA5|ON A# 1
AMA#5 OF FO|C&A# CA#C|NOMA --
|dent|f|ed by h|:to|oq|c ono|y:|:
Need|e b|o:y |: therefore not o re||ob|e method to
d|:t|nqu|:h between fo|||cu|or CA ond ce||u|or
odenomo--- (:uch tumor: ore :urq|co||y remoued
Ftl6t F0lllCulAR A0Ft0HA
5onoqroh|c feoture::
5o||d mo::e: thot moy be hyerecho|c, |:oecho|c, or
hyoecho|c
oue th|ch, :mooth er|hero| hyoecho|c ho|o
re:u|t|nq from the f|brou: co:u|e ond b|ood ue::e|: ---
reod||y :een by co|or Do|er |moq|nq
5ohe ond whee| oeoronce of b|ood ue::e|: --- :een
|n both hyerfunct|on|nq ond oor|y funct|on|nq
odenomo --- doe: not o||ow the detect|on of
hyerfunct|on|nq |e:|on:
Ftl6t F0lllCulAR A0Ft0HA. SPFCTRuH 0F
APPFARAtCFS
1ransverse lmages of 8L lobe and
8 lefL lobe of Lhyrold gland ln Lwo
paLlenLs show homogeneous
hypoecholc round Lo oval masses
wlLh surroundlng Lhln halo Lhe
capsule of Lhe adenoma 1r Lracheal
alr shadow C caroLld arLery C
LonglLudlnal lmage shows oval
hyperecholc leslon wlLh Lhlck
perlpheral halo u PlsLology of leslon
ln C noLe Lhe unlform capsule (arrow)
of Lhe mass LonglLudlnal lmage
shows oval mass wlLh lnLernal cysLlc
componenL l LonglLudlnal lmage
shows round hyperecholc
homogeneous mass (arrow) ln paLlenL
wlLh PashlmoLo's LhyroldlLls
CARClt0HA
Most primary thyroid cancers are of epitheIiaI origin and
are derived from foIIicuIar or parafoIIicuIar ceIIs
PapiIIary Ca of the thyroid
Accounts for 75% to 90% of aII cases
Peaks in both the 3
rd
and the 7
th
decade of Iife
Women are affected more often than men
Microscopic features:
MuIticentric within the thyroid gIand in at Ieast
20% of cases
Round, Iaminated caIcifications (psammoma
bodies) in the cytopIasm of papiIIary CA ceIIs are
seen in approx 35% of pxs
The major route of spread is through the Iymphatics
to nearby cervicaI LNs
PAPlllARY CA 0F THF THYR0l0
Px may present with enIarged cervicaI nodes and a
paIpabIe normaI thyroid gIand
Distant mets are very rare (2-3%) and most commonIy in
the mediastinum and Iung
CumuIative mortaIity after 20 years is typicaIIy onIy 4%
to 8%
SurvivaI is proIonged, especiaIIy with radio-iodine
treatment.
Presence of adjacent nodaI mets does not adverseIy
affect the px's prognosis
PAPlllARY CA 0F THF THYR0l0
as pecuIiar histoIogic (fibrous capsuIe, microcaIcifications)
and cytoIogic ("ground gIass" nucIei, cytopIasmic incIusions
in nucIeus, indentations of nucIear membrane) features
Sonographic characteristics:
ypoechogenicity (90% of cases), resuIting from cIoseIy
packed ceII content, with minimaI coIIoid substance
MicrocaIcifications, appearing as tiny, punctate
hyperechoic foci, either with or without acoustic shadows
In rare but usuaIIy aggressive cases of papiIIary CA of
chiIdhood, microcaIcifications may be the onIy
sonographic sign of the neopIasm, even w/o evidence of a
noduIar Iesion Fig 18-15
PAPlllARY CA 0F THF THYR0l0
Sonographic characteristics:
4 ypervascuIarity (90% of cases) with disorganized vascuIarity, mostIy
in weII-encapsuIated forms
4 CervicaI Iymph node mets >>> may contain tiny, punctate echogenic
foci caused by microcaIcifications. MainIy Iocated in the caudaI haIf of
the deep juguIar chain. OccasionaIy, metastatic nodes may be cystic
as a resuIt of extensive degeneration.
4 Cystic nodaI mets >>> show a thickened outer waII, internaI noduIarity,
and septations >>>> may appear pureIy cystic in younger pxs
4 Cystic Iymph node mets in the neck occur aImost excIusiveIy in
association with papiIIary thyroid CA but occasionaIIy with
nasopharyngeaI CA
4 PredominantIy soIid mass
4 Invasion of adjacent muscIes >>> indicates that the mass is maIignant
A 8
C
u
PAPlllARY CA. SHAll CA wlTH HlCR0SC0PlC C0RRFlATl0t
LonglLudlnal lmage shows 7
mm hypoecholc solld nodule
conLalnlng mlcrocalclflcaLlons 8
Mlcroscoplc paLhologlc lmage
shows mlcrocalclflcaLlons or
psammoma bodles" (arrows)
PAPlllARY THYR0l0 CA. SPFCTRuH 0F APPFARAtCFS
LonglLudlnal lmage demonsLraLes
exLremely hypoecholc solld nodule
w/o evldence of calclflcaLlon 8
LonglLudlnal lmage of Lhe Lhyrold of a
6year old px shows exLenslve dlffuse
mlcrocalclflcaLlon w/o dlscreLe mass
1hls ls a very rare appearance and ls
more ofLen encounLered ln chlldren
Lhan adulLs C LonglLudlnal and u
Lransverse lmages show hypoecholc
nodules LhaL conLaln echogenlc focl
caused by mlcrocalclflcaLlons 1r
Lracheal alr shadow C caroLld arLery
LonglLudlnal lmage shows hypoecholc
solld nodule wlLh Lhlck lrregular halo
and llnear calclflcaLlons aL anLerlor
margln (arrow) l Lransverse lmage
shows heLerogeneous buL lsoecholc
mass ln Lhe Lhe lsLhmus (arrow) LhaL
conLalns mlcrocalclflcaLlons and has
Lhlck lrregular halo
F0lllCulAR CA

nd
subLype of welldlfferenLlaLed Lhyrold Ca
ffecLlng women more Lhan men
1wo Lypes
Mlnlmally lnvaslve Lype encapsulaLed and only lnvaslve Lo capsular
vessels Lhese Lumors rarely meLs (810) and also have a low faLallLy raLe
(3)
Wldely lnvaslve Lype nonencapsulaLed and lnvaslve Lo ad[acenL Llssues
and vessels 3080 meLs and have a hlgh faLallLy raLe (30)
8oLh varlanLs of folllcular C teoJ to spteoJ tbtooqb tbe blooJstteom totbet
tboo tbe lympbotlcs ooJ Jlstoot metostoses to booe looq btolo ooJ llvet are
more llkely Lhan meLs Lo cervlcal lymph nodes
ln8 ls noL rellable ln dlfferenLlaLlng benlgn from mallgnanL folllcular
neoplasm because Lhe patho|og|c dx |s not based on ce||u|ar appearance but
rather on capsu|ar and vascu|ar |nvas|on (mosL folllcular nodules musL be
surglcally removed for accuraLe paLhologlc dx!
F0lllCulAR CA
5onoqroh|c feoture::
|rrequ|or tumor morq|n
1h|ch, |rrequ|or ho|o
1ortuou: or choot|c orronqement of |nterno| b|ood ue::e|:
A
8
C
,edu||ary CA of thyro|d |n a 38 yearo|d fema|e A A so||tary h|gh|y hypoecho|c we||
def|ned ova| nodu|e |s seen |n the |eft |obe 8 Sparsed per|phera| and centra|
vascu|ar|zat|on seen on co|or Dopp|er C ,edu||ary ca was dx on USgu|ded INA
(echogen|c need|e |ns|de the nodu|e)
8
C
AtAPlASTlC THYR0l0 CA
1y|co||y o d|:eo:e of e|der|y er:on:,
#ere:ent: one of the mo:t |etho| of :o||d tumor:
Account: for |e:: thon 2 of o|| thyro|d CA
s-yeor morto||ty rote of more thon 9s
!re:ent: o: ro|d|y en|orq|nq mo:: extend|nq beyond the q|ond
ond |nuod|nq odjocent :tructure:.
Often |noerob|e ot re:entot|on
Moy often be o::oc|oted w|th o|||ory or fo|||cu|or Co:,
re:umob|y rere:ent|nq o ded|fferent|ot|on of the neo|o:m
1end not to :reod u|o the |ymhot|c:, but |n:teod ore rone to
oqqre::|ue |oco| |nuo:|on of mu:c|e: ond ue::e|:
AtAPlASTlC THYR0l0
5onoqroh|c feoture:
orqe, hyoecho|c mo::
nco:e or |nuode b|ood ue::e|:
|nuode nech mu:c|e:
lYHPH0HA
Accoun|s lor approxima|clv 4 ol all |hvroid malinancics
Mos|lv non-Hodkin`s |vpc
Isuallv allcc|s oldcr womcn
A rapidlv rowin mass |ha| mav causc svmp|oms ol obs|ruc|ion
such as dvspnca and dvsphaia
In 70 |o 80 ol pxs, i| ariscs lrom a prc-cxis|in chronic
lvmphocv|ic |hvroidi|is (Hashimo|o`s |hvroidi|isi wi|h subclinical or
ovcr| hvpo|hvroidism
5-vcar survival ra|c rancs lrom almos| 90 in carlv-s|ac cascs |o
lcss |han 5 in advanccd, disscmina|cd discasc
lYHPH0HA
Sonoraphic lca|urcs:
x|rcmclv hvpocchoic and lobula|cd mass
Larc arcas ol cvs|ic nccrosis mav occur, as wcll as cncascmcn| ol
adaccn| ncck vcsscls
Color dopplcr imain:
Bo|h nodular and dillusc |hvroid lvmphomas mav appcar
mos|lv hvpovascular
Mav show blood vcsscls wi|h chao|ic dis|ribu|ion and AV
shun|s
Adaccn| parcnchvma mav bc hc|crocncous as a rcsul| ol
associa|cd chronic |hvroidi|is
e
THYR0l0 HFTASTASFS
Mc|s in |hc |hvroid arc inlrcqucn|, occurin la|c in |hc coursc ol
ncoplas|ic discascs as |hc rcsul| ol hcma|ocncous sprcad or lcss
inlrcqucn|lv a lvmpha|ic rou|c.
Mc|as|ascs usuallv arc lrom mclanoma (`9i, brcas| (21i, and rcnal
ccll (10i carcinoma.
Mav appcar as soli|arv, wcll-circumscribcd nodulcs or as dillusc
involvcmcn| ol |hc land
Sonoraphic lca|urcs:
Solid, homocncous hvpocchoic masscs, w/o calcilica|ions
FltF-tFF0lF ASPlRATl0t l0PSY
Mos| cllcc|ivc mc|hod lor dianosin malinancv in a |hvroid nodulc
Providcs morc dircc| inlorma|ion |han anv o|hcr availablc dianos|ic
|cchniquc
Salc, incxpcnsivc, and rcsul|s in bc||cr sclcc|ion ol pxs lor surcrv
Iinc-nccdlc |hrvroid aspira|cs arc ol|cn classilicd cv|opa|holoicallv
in|o |hc ll 4 ca|corics:
Nca|ivc (no malinan| ccllsi
Posi|ivc lor malinancv
Sucs|ivc ol malinancv
Non-dianos|ic
Limi|a|ion ol |hc |cchniquc: lack ol spccilici|v in |hc `
rd
rp >>>
bccausc ol |hc inabili|v |o dis|inuish lollicular or Hur|hlc ccll
adcnoma lrom |hcir malinan| coun|crpar|s
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
Mul|inodulari|v
Malinancv morc common in a soli|arv nodulc
Mul|inodulari|v is usuallv associa|cd wi|h bcnin discasc
Howcvcr, u|z wd hih rcsolu|ion |ransduccr consis|cn|lv
dcmons|ra|cs mul|iplc clinicallv occul| nodulcs w/c mav lalsclv
rcassurc |hc sonolois| >>> malinan| and bcnin nodulcs arc ol|cn
prcscn| |oc|hcr in |hc samc land >>> approx 10-20 ol papillarv
CA mav bc mul|iccn|ric >>>(prcscncc ol mul|iplc nodulcs wi|hin
|hc |hvroid docs no| indica|c bcnini|v
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
Comc| Tail Sin
Hihlv spccilic sin ol bcnini|v
Solid/Cvs|ic
lL ls also belleved LhaL cysLlc nodules are benlgn Powever Lrue eplLhellal
Lhyrold cysLs are rare and Lhe cysLlc nodules seen on uLz lnvarlably have a
solld componenL
nodules wlLh large cysLlc componenLs are usually benlgn nodules LhaL have
undergone cysLlc degeneraLlon or hemorrhage
lmosL 030 of paplllary carclnomas also have a cysLlc componenL
lndlcaLlng LhaL oot oll cystlc tbytolJ ooJoles ote beolqo
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
chocnici|v
Incidcncc ol malinancv is onlv 4 whcn a solid |hvroid lcsion is
hvpcrcchoic.
Il |hc lcsion is iso-cchoic |hc incidcncc ol malinancv incrcascs |o
26
Malinancv occurs in 6` ol hvpocchoic masscs
In dailv prac|icc, howcvcr, bcnin nodulcs arc vcrv common and a
soli|arv hvpocchoic nodulc is s|a|is|icallv morc likclv |o bc bcnin
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
Marins
A pcriphcral halo ol dccrcascd cchocnici|v is sccn around iso-
hvpcrcchoic nodulcs >>> causcd bv ci|hcr |hc capsulc ol |hc nodulc
or comprcsscd |hvroid |issuc and vcsscls
A complc|c halo around |hc lcsion is 12 |imcs morc likclv |o
indica|c a bcnin lcsion
Il |hc halo is incomplc|c, a bcnin lcsion is s|ill 4 |imcs morc likclv
|han a malinan| lcsion
Halo mav also bc sccn in 15-`0 malinancics (i|s prcscncc is no|
pa|honomonic ol bcnini|v
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
Calcilica|ion
Pcriphcral rim calcilica|ion and larc arcas ol coarsc shadowin calcilica|ion arc
morc lrcqucn|lv sccn in bcnin nodulcs
Iinc punc|a|c calcilica|ion duc |o calcilicd psammoma bodics is sccn in papillarv
CA (25-40i >>> also sccn in mc|as|a|ic nodcs lrom papillarv CA
Small calcilic loci >>> mav bc sccn in mcdullarv CA, bo|h wi|hin |hc primarv
|umor and mc|as|a|ic ccrvical nodc
0lFFFRFtTlATl0t 0F Ftl6t At0
HAll6tAtT t00ulFS
Color llow imain
Thrcc cncral pa||crn ol vascular dis|ribu|ion
Tvpc 1: complc|c abscncc ol llow sinal wi|hin |hc nodulc
Tvpc II: cxclusivc pcrinodular ar|crial llow sinals
Tvpc III: in|ranodular llow wi|h mul|iplc vascular polcs chao|icallv arrancd, wi|h
or wi|hou| sinilican| pcrinodular llow
Tvpc I and II arc sccn in bcnin hvpcrplas|ic nodulcs
Tvpc III is cncrallv associa|cd wi|h malinan| nodulcs
FXAHltATl0t 0F A0JACFtT
STRuCTuRFS
Common caro|id ar|crv and In|crnal uular vcin
Prcscncc ol |hrombus, in associa|ion wd a |hvroid nodulc, is a cluc |o
|hc malinan| na|urc ol |hc nodulc
Tumor |hrombus >>> morc commonlv sccn in lollicular and
anaplas|ic CA
Sprcad |o adaccn| s|ruc|urcs
Involvcmcn| ol |hc s|rap musclcs is ano|hcr cluc |o |hc malinan|
na|urc ol |hc |hvroid nodulc
Loss ol |hc normal lascial planc bc|wccn |hc |hvroid and s|rap
musclcs and ill-dclincd ou|lincs ol |hc musclc
x|ra|hvroid sprcad >>> csophaus, |rachca, s|rap musclcs and
rccurrcn| larvncal ncrvc >>> malinan|
FXAHltATl0t 0F A0JACFtT
STRuCTuRFS
Bcnin ccrvical LNs
Isuallv havc a slcndcr, oval shapc and ol|cn cxhibi|
a ccn|ral cchocnic band |ha| rcprcscn|s |hc la||v
hilum
Malinan| LNs
Ol|cn loca|cd in |hc lowcr `
rd
ol |hc ncck and arc
usuallv roundcr and havc no cchocnic hilum >>>
bcc ol obli|cra|ion bv |umor inlil|ra|ion
CFRvlCAl t00FS
$onographic features for the characterization of malignant
and benign nodules.
D l1D8 MallgnanL 8enlgn
olld ++++ ++
Mlxed ++ +++
CysLlcpurely Lhln
sepLa
+ ++++
Pypoecholc +++ +++
lsoecholc ++ +++
Pyperecholc + ++++
1hlck lncompleLe
halo
+++ +
+ very low probablllLy ++ low probablllLy +++ lnLermedlaLe probablllLy ++++
hlgh probablllLy
$onographic features for the characterization of
malignant and benign nodules.
D l1D8 MallgnanL 8enlgn
1hln halo ++ ++++
oorlydeflned
marglns
+++ ++
Welldeflned
marglns
++ +++
MlcrocalclflcaLlons ++++ ++
ggshell
calclflcaLlons
+ ++++
Coarse
calclflcaLlons
+ +++
lnLernal flow
paLLern
+++ ++
erlpheral flow
paLLern
++ +++
+ very low probablllLy ++ low probablllLy +++ lnLermedlaLe probablllLy ++++ hlgh
probablllLy
THAtK Y0u!!!