This document discusses the evaluation of thyroid lesions using sonography. It outlines common thyroid disorders such as enlargement, nodules, hyperthyroidism and hypothyroidism. Imaging approaches like ultrasound, thyroid scintigraphy, CT and MRI are discussed. Sonography can detect masses, cysts, calcifications, tissue texture changes and cervical lymph nodes. Benign lesions like cysts, hematomas, and inflammatory conditions are described. Malignant lesions like papillary carcinoma are also outlined, noting features like ill-defined margins, hypoechogenicity, microcalcifications, hypervascularity and cervical lymph node involvement. Thyroid nodule isotope scans can identify hot or cold nodules.

1. Thyroid lesions – Evaluation with Sonography
Presented BY
DR Laith Al hialy

2. thyroid disorders – presentation
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thyroid gland
enlargement (Goiter )
Palpable nodule
Hyperthyroidism
Hypothyroidism
Cervical - LN

3. Imaging Approach
for thyroid nodule 2 – institutions ways
• US ( 7-10 MHZ liner – with Doppler study)
• thyroid scintigraphy
( radionuclide
Tc , 123 Iodine )
99m
• CT , MRI ( none palpable nodule )
• FNA Biopsy
• Palpable Nodule > 1 cm
direct biopsy
• Nodule < 1 cm , Cyst also
not appreciated

4. BY sonographic
examination
what we can detected ?
• Mass ( nodule Solitary –
multiple )
• Cyst
• Calcification
• Change in thyroid
tissue texture
• Cervical LN

5. Goiter could be presented as retrosternal upper mediastinal mass

6. Goiter could compress the trachea
Before
after thyroidectomy

7. Benign lesion
1. Cyst lesion
Most common colloid
cyst
Anechoic , well defined ,
comet tail appearance
2. Hematoma
happen with
degenerative nodule

8. Benign lesion
Nodule ( hyperplasic or
adenomatous )
Well defined , smooth margin ,
texture echogenic –isoechoic ,
fine hypoechoic rim , curvilinear
fine calcification with faint
acoustic shadow , equivocal
vascularity by Doppler, internal
hemorrhage

9. Benign lesion
Inflammatory
condition
Hashimoto’s Thyroiditis.
typical sonographic features
include: a diffusely enlarged
gland demonstrating
hypoechoic areas with a very
disorganized and
heterogeneous pattern

10. Malignant lesion
Papillary carcinoma is the most
common thyroid malignancy 75 %
Follicular, Medullary and Aplastic
carcinomas and lymphoma make up the
remaining 25%
Metastases from lung, breast, and colon
cancers
ill defined margin, hypoechoic and
punctuate –micro calcifications
(
psammomatous calcification)
with acoustic shadow
Hyper vascularity by Doppler
Thick halo 1-2 mm , cervical LN

11. Malignant nodule
NHL of thyroid

12. Thyroid nodule isotopes scan
Hot nodule
cold nodule