Thyroid

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of diseases of thyroid gland:

1) Agenesis of the thyroid:

Sonography of the thyroid in this 1 yr. old female child revealed congenital absence of the entire thyroid. Note the empty fossae where the right and left lobes would normally lie. The carotid artery and jugular vein of both sides are seen in the color doppler images. These ultrasound and color doppler images suggest congenital agenesis of the thyroid.

Reference: http://content.nejm.org/cgi/content/abstract/321/1/13 (free abstract).

2) Hemiagenesis of the thyroid:

This 18 yr. old female patient presented with symptoms of hypothyroidism. On sonography of the thyroid, we observed: 1) absence of the right lobe of thyroid 2) normal or slightly enlarged left lobe and isthmus of thyroid c) mild to moderate augmentation of vascularity of the left lobe on color doppler imaging. These ultrasound images favor a diagnosis of congenital absence of the right lobe or hemiagenesis of the right lobe with Hashimoto's thyroiditis. This condition is found typically in females with left lobe usually absent.

Reference: 1) http://medind.nic.in/iaw/t05/i2/iawt05i2p53.pdf (free article and images)

3) Dysgenesis of thyroid- ectopic thyroid tissue:

This young, adult female patient complained of a midline swelling of the neck. Clinically, the nodule was palpated in the midline, at the level of the thyroid cartilage and moved with swallowing (deglutition). Ultrasound images of the nodule showed it to be solid, with no cystic areas or calcification. Power Doppler imaging showed moderate vascularity of the nodule. The echogenicity and echotexture of the lesion was same as that of normal thyroid tissue. The thyroid fossa was empty with none of the normally located (orthotopic) thyroid seen. The nodule was long along the sagittal axis (4 x 2 x 1 cms.). These ultrasound images suggest dysgenesis of the thyroid with ectopic thyroid tissue in the midline of the neck. This tissue appears to show goitrous enlargement and appears to be the only available thyroid tissue in this patient.

Reference: http://www.medcyclopaedia.com/library/topics/volume_vi_2/e/ectopic_thyroid.aspx

4) Hashimoto's thyroiditis:

Sonography of the thyroid gland in this middle aged female patient reveal:

1) hypoechoic thyroid gland 2) coarse echotexture of the gland 3) fine linear echoes within the thyroid parenchyma s/o fibrosis 4) Color doppler imaging reveals augmentation of the vascularity of the thyroid gland. These ultrasound images are diagnostic of Hashimoto's thyroiditis. Images taken using a Toshiba Nemio- XG color doppler machine.

Reference: 1) Hashimoto's thyroiditis article (free article and images)

2) http://www.emedicine.com/med/TOPIC949.HTM (free article and images)

5) Hyperthyroidism:

These ultrasound/ color doppler images (taken with a Nemio-XG color doppler scanner), reveal markedly increased vascualrity throughout the thyroid gland. Some degree of inhomogeneity is also present. The patient was a middle aged female with typical features of thyrotoxicosis. Ultrasound images are diagnostic of hyperthyroidism.

Reference: http://www.emedicine.com/Radio/topic315.htm (free article)

6) Multinodular goiter:

The above ultrasound images show- 1) a huge complex mass (8 x 6 cms.) containing both cystic and solid areas, in the right lobe of the enlarged thyroid. 2) relatively spared left lobe which shows normal size, but has fine nodularity. These ultrasound images are highly suggestive of a multinodular goitre.

http://www.patient.co.uk/showdoc/27000670/ (free article)

7) Ultrasound and color doppler imaging of multinodular goiter:

The above ultrasound and color doppler images reveal multiple cystic lesions in both lobes of the thyroid. There is also evidence of few nodular, solid masses within the lobes. Color doppler imaging reveals multiple vessels around the lesions. These images suggest multinodular goiter, more of a cystic variety.

8) Sublingual thyroid:

This young lady had a swelling in the right side of upper neck of acute onset. Ultrasound images of the neck reveal an extension of the right lobe of thyroid gland into the sublingual region of the neck. This showed a thick-walled cyst with thickened septae within it. The left lobe of thyroid also shows a simple colloid adenoma (cyst) within it. These ultrasound images suggest hemorrhagic cyst of sublingual thyroid. Images taken with an ATL ultrasound machine courtesy of Mr. Shlomo Gobi, Israel.

Reference: 1) http://www.ajnr.org/cgi/reprint/16/5/1117.pdf (free article)

2) http://jcem.endojournals.org/cgi/content/full/88/11/5145 (free article and images)

3) http://pediatrics.aappublications.org/cgi/content/abstract/38/4/647 (abstract)

9) Ultrasound image of hemithyroidectomy:

This sonographic image shows a post-surgical absence of the right half of the thyroid gland. Hemithyrodiectomy is usually done in cases of suspected thyroid malignancy. Here the normal left half of the thyroid is seen in transverse section. Ultrasound image taken with a Toshiba Powervision color doppler/ ultrasound machine, courtesy of Dr. Ravi Kadasne, MD, UAE.

Reference: Thyroidectomy article

10) Superficial neck masses- lipoma:

<<The normal thyroid is visualized above the mass, though small in size.

This teenaged female presented with a palpable and visible mass in the suprasternal region just below the thyroid. On sonography, the mass is homogenous in echotexture, measures 5.5 x 2.5 x 2.6 cms., relatively hyperechoic with echogenicity just less than the normal thyroid (which was well visualized). Color doppler imaging shows no vascularity in the mass. These ultrasound images suggest either an ectopic thymic mass or a subcutanous mass like lipoma. The mass was aspirated and proved to be a lipoma of the neck. Images taken using a Toshiba Nemio XG by Joe Antony, MD, India.

Reference: http://www.ajnr.org/cgi/reprint/19/3/505 (an excellent free article and images).

11) Hemorrhagic colloid cyst of the thyroid:

The above sonographic images of the right lobe of thyroid show a large cyst measuring 1.8 x 1.5 cms. The walls appear irregular with fine debris within the lumen of the thyroid cyst. Color doppler image (on right) shows normal vascularity with no vessels within the cyst. These ultrasound images suggest Hemorrhagic colloid cyst of the thyroid.

Reference: http://www.emedicine.com/Radio/topic695.htm

Follow up ultrasound images (same patient above) 2 months later:

The colloid cyst, has almost completely resolved and measures 0.8 cms. in size. Such dramatic improvement and reduction is known to occur in colloid cyst of the thyroid, especially if hemorrhagic in nature.

12) Malignant thyroid nodule:

This patient underwent sonography of the thyroid, revealing a markedly hypoechoic nodule of 1.1 cms. width, in the left half of the isthmus of the thyroid. The lesion also shows echogenic specks s/o microcalcification and an irregular border. Also note that the nodule is as tall as it is wide. All these ultrasound findings favor a diagnosis of malignancy on this thyroid nodule. Images courtesy of Dr. Ravi Kadasne, UAE.

Reference: http://www.ajronline.org/cgi/reprint/178/3/687.pdf (excellent article-- free)

13) Benign nodules of the thyroid:

a) Follicular adenoma:

Sonography of the thyroid was done in this young girl. There is a large, solid, echogenic, homogenous oval nodule with a hypoechoic halo around the lesion, in the right lobe of thyroid. The lesion is solitary, shows no cystic areas and has a rim of vessels entering it's central area. These ultrasound images are diagnostic of a benign follicular adenoma of the thyroid. Note the similarity of the egg-shaped lesion to a sonographic image of the testes.

b) Adenomatous nodules:

Synonyms: Colloid nodules:

Case-1:

Case-2: Adenomatous (Colloid nodules):

Both the above cases (1 and 2) show large, well-defined complex masses in the thyroid gland. In case 1 the masses are multiple. Both patients show multiple vessels along the rim of the masses and have cystic areas in a primarily solid mass. Unlike follicular adenoma, the masses are inhomogenous and multiple. Few intranodular vessels are present. There is a poorly defined halo (marginal hypoechoic rim) in these lesions. These ultrasound features/ images are highly suggestive of adenomatous or colloid nodules of the thyroid gland. The vast majority of thyroid nodules fall in this category.

Reference: http://emedicine.medscape.com/article/385301-overview (free article and images).

14) Parathyroid adenoma:

Adenoma of the parathyroid gland:

The parathyroid glands are located posterior to both lobes of the thyroid gland are 4 in number, the superior and inferior pairs. The parathyroid glands regulate the metabolism of calcium in the body and parathyroid hormone (PTH) causes increase in calcium level in the blood. The commonest cause of Hyperparathyroidism is parathyroid adenoma. Sonography of the parathyroid glands (above) shows a markedly hypoechoic, oval mass seen posterior to the left lobe of thyroid. These ultrasound images are suggestive of parathyroid adenoma. Both above images of parathyroid adenoma are courtesy of Dr. Durr E Sabih, Pakistan.

Reference: http://emedicine.medscape.com/article/384024-overview (free article and images)

Case-2 : Parathyroid adenoma in child:

This was a 9 yr. old female child with hypercalcemia and nephrolithiasis. Ultrasound imaging of the left thyroid and parathyroids show a hypoechoic mass in the region posterior to the lower pole of left lobe of thyroid (similar location as in case-1). The image in bottom row is a 3-D ultrasound image of the parathyroid adenoma. (THYR= thyroid, left lobe). All sections are oblique longitudinal views of the lesion seen via the left lobe of thyroid gland. Images are courtesy of Ravi Kadasne, MD, UAE.

Another case of Parathyroid adenoma (case-3):

This was a middle aged female patient with suspected thyroid pathology. Ultrasound images show a relatively large, well encapsulated hypoechoic mass of 1.1 x 0.5 cms. in the posterior aspect of the right lobe of thyroid. The main differential diagnosis in this case is a parathyroid adenoma (right -lower). The color Doppler images show marked vascularity with an arc of vessels around the lesion. This is a highly suggestive sign of parathyroid adenoma. The other main differential diagnosis is "hot" autonomous nodule of the thyroid gland (less likely). The vessels show both arterial and venous flow within this lesion.

Reference: http://www.jultrasoundmed.org/cgi/content/abstract/13/4/303)

Case-4: Huge parathyroid adenoma:

This is a huge left parathyroid adenoma. Again the mass is typical in location, and markedly hypoechoic. However, the size is an astonishing 4.2 x 1 cms., one of the largest I have seen. The long section shows its elongated nature, extending along (posterior to) the length of the left lobe of thyroid. Ultrasound images are courtesy of Dr. Ravi Kadasne, MD, UAE. The color Doppler image shows considerable vascularity in the parathyroid mass.

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This page was last edited on: Tuesday August 31, 2010 04:33 PM

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