Thyroid Pathology

a goiter is defined as an

enlarged, hyperplastic thyroid gland

causes of a goiter

iodine deficiency, graves disease, and thyroiditis

thyroid enlargement can be diagnosed by calculating

volume measurements ot by obtaining an AP thickness of the thyroid isthmus

an isthmus that measures greater than — may be indicative of thyroid enlargement

1 cm

The thyroid isthmus measured 13 mm (between calipers), which is indicative of a goite

A normal thyroid gland and thyroid isthmus (2 mm) are shownclinical findings of a

clinical findings of a goiter

1. palpable (and possibly visually) enlarged thyroid gland

2. dyspnea

3. dysphagia

4. feeling of tightening in the throat

5. coughing

6. hoarseness

sonographic findingd of a goiter

1. enlarged thyroid gland (isthmus that exceeds 1 cm in the AP plane)

2. diffusely heterogeneous echotexture

3. multiple nodules with cystic and solid components

goiter is a general term for — that can result from inadequate iodine intake

thyroid enlargment

hyperthyroidismis a condition that results from the

overproduction of thyroid hormones

graves disease aka —

diffuse toxic goiter

the term — may be noted as hypervascularity within the thyroid gland

thyroid inferno

clinical findings of graves disease

1. buldging eyes

2. heat intolerance

3. nervousness

4. weight loss

5. hair loss

sonographic findings of graves disease

1. enlarged gland

2. heterogeneous or diffusely hypoechoic echotexutre

3. thyroid inferno

Hyperthyroidism. Transverse (A) and longitudinal (B) images with color Doppler in a patient with hyperthyroidism revealing hyperemia. (Color image provided online.)

— is the most common cause of hyperthyroidism.

Graves disease

— is the most common form of thyroid cancer

papillary carcinoma

other forms of thyroid malignancies

follicular carcinoma, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastases of the thyroid

hypothyroidism is a condition that results from the

underproduction of thyroid hormones

Hashimoto thyroiditid is an

autoimmune disease

the most common cause of hypothyroidism in the United States

hashimotos thyroiditis

hashimoto thyroiditis may also be referred to as

chronic autoimmune lymphocytic thyroiditis

with hashimoto disease, the thyroid becomes inflamed, as, as a result, the thyroid produces —

smaller amounts of thyroid hormones

in order to compensate for hashimoto disease, the pituitary gland releases more —, which causes the thyroid to become enlarged

TSH

the end-stage of hashimoto disease may actually lead to —

fibrosis and atrophy of the gland

Hashimoto thyroiditis. A. Transverse image of the thyroid gland in a patient with hypothyroidism revealing a diffusely coarse, heterogeneous gland. The trachea (Tr) and carotid arteries (C) are also demonstrated. B. Longitudinal image of the same patient.

clinical findings of hashimoto thyroiditis

1. depression

2. increased cold sensitivity

3. elevated blood cholesterol levels

4. slight weight gain may occur

5. puffy face and puffiness under the eyes

sonographic findings of hashimoto thyroiditis

1. mild enlargement of the thyroid gland (initially)

2. heterogeneous echotexture

3. multiple, ill-defined hypoechoic regions seperated by fibrous hyperechoic tissue

4. hypervascular gland

hashimoto thyroiditis is the most common cause of —

hypothyroidism

— are the most common masses identified within the thyroid gland with sonography

benign thyroid nodules

follicular adenomas are most often —

small, round, and can have varying sonographic appearances, including completely anechoic, isoechoic, or hyperechoic.

follicular adenomas may also have a

surrounding halo

— is the most common cause of thyroid nodules

nodular hyperplasia

aka for hyperplastic nodules

adenomatous nodules

hyperplastic nodules are almost always — and have varying sonographic appearances

multiple

benign characteristics of thyroid nodules

• extensive cystic components

• cysts <5 mm

• hyperechoic mass

• “eggshell” calcifications

• “hot” nodules (nuclear medicine)

malignant characteristics of thyroid nodules

• hypoechoic mass

• taller-than-wide

• mass with internal microcalcifications (psammoma bodies)

• solitary mass

• marked vascularity within the central part of the nodule

• interrupted peripheral calcification

• extracapsular invasion

• lobulated margins

• enlargment of the cervical lymph nodes (metastasis)

• “cold” nodule (nuclear medicine finding)

nuclear medicine utilizes scintigraphy to classify thyroid nodules as either

hyperfunctioning or hypofunctioning

hyperfunctioning or “hot nodules” yield — on a thyroid nuclear medicine scan

dark areas

hypofunctioning or “cold nodules” yield — on the nuc med scan

light or blank areas

most cancers are — nodules and will appear as — on nuc med scans, but thats not always the case

hypofunctioning; cold nodules

Colloid cyst. Transverse image of the thyroid revealing a small colloid cyst (arrow) with a small, hyperechoic focus contained within it that is producing comet-tail artifact.