Thyroid

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

Ultrasound images of diseases of thyroid gland:

Contents of this page:

1) Agenesis_of_the_thyroid

2) Hemiagenesis of the thyroid

3) Dysgenesis of thyroid- ectopic thyroid tissue

4) Hashimotos thyroiditis

5) Hyperthyroidism

6) Multinodular goiter

7) Ultrasound and color doppler imaging-multinodular goiter

8) Ultrasound image of hemithyroidectomy

9) Superficial neck masses- lipoma

10) Hemorrhagic colloid cyst of the thyroid

11) Malignant thyroid nodule

     Case-2: Papillary carcinoma of left lobe thyroid

     Case-3: Biopsy proven papillary carcinoma of thyroid- Right lobe

12) Benign nodules of the thyroid

a) Follicular adenoma

b) Adenomatous nodules

13) Ectopic thyroid tissue

14) Parathyroid adenoma

a)  Case-2: Parathyroid adenoma in child

b) Another case of Parathyroid adenoma (case-3)

c) Case-4: Huge parathyroid adenoma

15) Thyroglossal duct cyst

16) Thyroglossal duct cyst inflammation/ abscess

 Sonographic atlas of the thyroid - a text book on thyroid ultrasound

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).

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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) 

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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   

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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)

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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)

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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)

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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.

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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)

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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

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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).

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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:

Case-1:

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)

Case-2: Papillary carcinoma of thyroid- Left lobe:

Left lobe- long section:                                         Left lobe nodule-long section- color Doppler-

Transverse section of thyroid:

This was a patient with a biopsy proven case of papillary carcinoma of the left lobe. The large hypoechoic mass is seen infiltrating large portions of the left lobe. No definite evidence of microcalcifications is seen. However color Doppler ultrasound shows marked increase in color flow within the affected part of the left lobe. The margins of the tumor appear poorly defined with absence of a clear hypoechoic halo around the mass. These ultrasound images of papillary carcinoma of the thyroid gland are courtesy of Dr. Ravi Kadasne, MD, UAE. Malignant masses of the thyroid are relatively rare and malignant transformation of thyroid nodules occur in as low as 7 % of nodules. Among thyroid malignancies, the commonest is papillary carcinoma and this variety of carcinoma has the best prognosis. The other forms of thyroid carcinoma are follicular, medullary and anaplastic. Of these the anaplastic carcinoma of the thyroid carries the highest mortality rate with a 5 year survival rate of less than 5 %. Papillary carcinoma of the thyroid has a 20 year survival rate of 95 %.

References: http://radiographics.rsna.org/content/27/3/847.full.pdf+html (free article on sonography of Papillary carcinoma of thyroid)

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Case-3: Biopsy proven papillary carcinoma of thyroid- Right lobe:

Right lobe mass with microcalcifications                   Color Doppler image- right lobe

Microcalcifications in nodule:                              3D image of the mass in right lobe- showing calcifications

Post operative snap of the surgically removed mass:

This was yet another case of proven papillary carcinoma of the thyroid of the right lobe. The ultrasound images show a large, inhomogenous, hypoechoic mass of the right lobe with multiple calcific foci (microcalcifications). The ultrasound findings are confirmed by 3D sonography of the lesion which shows the calcific foci in clear contrast. Color Doppler image of the right lobe (long section) shows marked increase in internal vascularity of the nodule. Ultrasound images of this case of papillary carcinoma of thyroid are courtesy of Dr. Ravi Kadasne, MD, UAE.

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13) Benign nodules of the thyroid:

a) Follicular adenoma:

Case-1:

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.

Case-2: Large Follicular adenoma of right lobe of thyroid:

This 30 yr. old female patient has a right sided thyroid nodule. The nodule moved with deglutition and seemed to occupy a large part of the right lobe. Ultrasound images show a solid, egg-shaped mass which has features similar to the previous case-1 (above). However, this thyroid nodule is much larger (at 4 x 1.5 cms.). Note the absence of cysts or calcification within the thyroid nodule. These ultrasound appearances are typical of right follicular adenoma of the thyroid. The main differential diagnosis in this case is adenomatous nodule of the thyroid. However, as mentioned, the homogenous appearance, absence of cysts and solitary nature of this nodule are in favor of a follicular adenoma.

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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).

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14) Ectopic thyroid tissue:

 This young female patient has an ectopic thyroid nodule just above the thyroid cartilage with co-existing (orthotopic) thyroid in the normal thyroid fossa. The ectopic thyroid nodule shows solid tissue and is possibly functional. However, it may be surgically removed, if needed, as functional thyroid tissue is seen in normal location. The orthotopic thyroid gland shows changes of Hashimoto's thyroiditis.

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15) 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)

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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)

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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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16) Thyroglossal duct cyst:

This 4 year old male child showed a gradually increasing swelling just left of the midline (see snaps above). Sonography of the neck showed a normally located thyroid gland (see ultrasound image top- left) or orthotopic thyroid which was normal in structure and echogenicity. However, the ultrasound image on right shows the cystic mass seen in the photos in lower row. The cyst is well defined and has no significant vessels in its walls. The cyst shows clear fluid content and no septae or nodules. These findings favor a diagnosis of thyroglossal duct cyst. Thyroglossal duct cysts though usually seen in the midline, may be located, slightly on one side (here just left of the midline). The cyst showed movement with deglutition. Surgery would be an ideal option in this case, as the thyroglossal duct cyst does not contain functioning thyroid tissue; besides, the child has a normal orthotopic thyroid gland.

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17) Thyroglossal duct cyst inflammation/ abscess:

This new born baby had a swelling and tenderness over the lower submandibular region/ chin. Ultrasound images of this region showed a midline hypoechoic region with fine echoes within it. The margins of the cystic lesion appear thick-walled and irregular. Power Doppler image (lower left), shows considerable vascularity around the walls of the cyst suggesting inflammation. The cyst measures 2.4 x 1.7 cms. in size, and shows no septae. The midline location of this cystic mass suggests possibility of thyroglossal duct cyst, with the other ultrasound findings suggesting inflammation or abscess formation. Thyroglossal duct cysts are the commonest cause of neck and chin swellings in the neonate/ newborn. Inflammation following infection of the thyroglossal duct cyst is a common and known complication of this lesion. Thyroglossal duct cysts may be suprahyoid (above the hyoid cartilage), as in this case, hyoid level, or infrahyoid in location. They may be midline (usually) or just to the side of the midline. Below are some snaps of the neonate's chin. This case and ultrasound images of thyroglossal duct cyst abscess are courtesy of Mr. Shlomo Gobi, sonographer, Israel.

Reference: http://www.jultrasoundmed.org/cgi/reprint/27/8/1211

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Sonographic atlas of the thyroid:

Do you wish to read more on ultrasound imaging of the thyroid?

I have published a short easy to read book on sonography of the thyroid, printed and distributed world wide by Jaypee brothers, India. Very inexpensive and easy to master, this short handbook uses the best ultrasound images of most thyroid diseases to explain the various pathology affecting the thyroid gland and its sonographic diagnosis. Sonography of the thyroid is perhaps one of the most affordable and safest method of studying thyroid diseases. My book: "Sonographic atlas of the thyroid and appendix" explains almost every thyroid condition the reader would encounter during his/ her ultrasound practice.

I have added a short section on various appendicular pathologies and its ultrasound diagnosis. Both parts of this short atlas of the thyroid and appendix will help the reader master the sonography of thyroid diseases as well as expose him to different types of appendicular diseases.

This excellent book is available in Jaypee brothers book shops in India and can also be bought online from a number of dealers. Visit:

1) http://www.printsasia.com/book/Step-by-Step-Sonographic-Atlas-of-Thyroid-Appendix-Joe-Anthony-8184489986-9788184489989

2) sonographic atlas of thyroid and appendix

3) Ultrasound atlas of thyroid and appendix

4) Sonography of the thyroid-  Jaypee brothers website
5) http://www.bookshopofindia.com/search.asp?action1=default&bookid=9081727
6) http://www.maansu.com/9788184489989
7) Sonographic atlas of the thyroid and appendix- Amega books 
8) http://www.flipkart.com/b/books/step-sonographic-atlas-thyroid-appendix-book-8184489986

Priced at very affordable rates, this text book on ultrasound imaging of the thyroid is a must buy for the novice sonographer as well as the professional who wish to know more about thyroid ultrasound.

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  This page was last edited on: Monday December 26, 2011 03:54 PM  

Copyright ©   2007- All rights reserved- www.ultrasound-images.com Dr. Joe Antony, MD, Cochin- 20, India.

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