Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 21;19(1):13-29.
doi: 10.1002/ajum.12001. eCollection 2016 Feb.

Sonography of diffuse thyroid disease

Hok Yuen Yuen  1 , Ka Tak Wong  1 , Anil Tejbhan Ahuja  1
Affiliations

Sonography of diffuse thyroid disease

Hok Yuen Yuen et al. Australas J Ultrasound Med. .

Abstract

Introduction/purpose: This article aims to review of the common diffuse thyroid disease.

Methods: Thorough literature search and review was performed for each diffuse thyroid disease. The most recent and updated ultrasound images were obtained.

Results: Diffuse thyroid diseases discussed include multinodular goitre, Graves' disease, Hashimoto thyroiditis, de Quervain thyroiditis, acute suppurative thyroiditis, anaplastic carcinoma, thyroid metastases, chronic lymphocytic leukaemia/small lymphocytic lymphoma, Langerhans cell histiocytosis, tuberculosis, plasmacytoma, IgG4-related disease and thyrolipoma.

Discussion: The major clinical features and the sonographic features of each diffuse thyroid disease are reviewed.

Conclusion: This article serves as a synopsis of diffuse thyroid disease.

Keywords: diffuse thyroid disease; ultrasound.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Transverse grey scale ultrasound shows the typical appearance of multinodular goitre as a well‐marginated, diffuse enlargement of the thyroid gland with a heterogeneous, nodular appearance (arrows).
Figure 2
Figure 2
Transverse grey scale ultrasound shows the spongiform appearance (arrows) of aggregation of multiple microcystic components in >50% of the nodule volume that is highly specific for benign hyperplastic nodule.
Figure 3
Figure 3
Longitudinal grey scale ultrasound shows a predominantly cystic nodule. The solid component (curved arrow) within the cystic component ‘*’ is due to blood clot, and invariably avascular on Doppler.
Figure 4
Figure 4
Transverse grey scale ultrasound shows the tiny, non‐shadowing echogenic foci with ‘comet‐tail’ artifacts (arrows) that are highly suggestive of colloid content.
Figure 5
Figure 5
Transverse (a) and longitudinal (b) power Doppler ultrasound shows the markedly increased parenchymal vascularity in Graves’ disease giving the appearance of ‘thyroid inferno’.
Figure 6
Figure 6
Transverse grey scale ultrasound shows diffuse hypoechoic goitre (arrows) with ill‐defined patchy hypoechoic areas separated by echogenic fibrous septa (curved arrow) in acute diffuse Hashimoto thyroiditis.
Figure 7
Figure 7
Transverse power Doppler ultrasound shows a focal, ill‐defined, avascular, hypoechoic nodular area in the subcapsular region (arrow) in the acute phase of de Quervain thyroiditis.
Figure 8
Figure 8
Longitudinal grey scale ultrasound of the same case as in Figure 7 shows that in the subacute phase of de Quervain thyroiditis there is progression to involve almost the entire lobe (arrows).
Figure 9
Figure 9
Transverse grey scale ultrasound in acute suppurative thyroiditis shows a focal abscess in the left lobe of thyroid in the form of an ill‐defined hypoechoic lesion (arrow) with adjacent inflammatory thickening. The common carotid aretries (arrowheads) and the left internal jugular vein (curved arrow) are intact.
Figure 10
Figure 10
Axial contrast enhanced CT of the same case as in Figure 9 shows the focal thyroid abscess as an ill‐defined poorly enhancing hypodense lesion (arrow). The common carotid arteries (curved arrows) and internal jugular veins (arrowheads) are intact and patent.
Figure 11
Figure 11
A barium swallow study of the same case as in Figures 9 and 10 delineates the left pyriform fossa sinus (arrows) associated with a fourth branchial cleft anomaly.
Figure 12
Figure 12
Transverse grey scale ultrasound shows an anaplastic carcinoma of thyroid as an ill‐defined hypoechoic tumour diffusely infiltrating the entire gland (arrows). Note the dense amorphous calcifications (curved arrows).
Figure 13
Figure 13
Transverse grey scale ultrasound of the same case as in Figure 12 shows an enlarged, roundish, hypoechoic nodal metastasis (arrows) with cystic necrosis (curved arrow) from the anaplastic carcinoma.
Figure 14
Figure 14
Longitudinal power Doppler ultrasound shows a thyroid metastasis as an ill‐defined, heterogeneous hypoechoic lesion (arrows). Note the scanty vasculrity. Patients with thyroid metastases often have extensive metastatic disease in the rest of the body and thus a poor prognosis.
Figure 15
Figure 15
Coronal reconstructed CT image of the same case as in Figure 14 shows the primary bronchogenic carcinoma in the medial aspect of the lower lobe of the right lung) ‘*’).
Figure 16
Figure 16
Transverse grey scale ultrasound shows a heterogeneous, hypoechoic goitre of the right lobe of thyroid (arrows). Adjacent abnornal right jugular chain lymph node with loss of normal architecture (curved arrow) is present. Biopsy revealed leukaemia.
Figure 17
Figure 17
Transverse grey scale ultrasound shows a diffuse goitre with heterogeneous, hypoechoic echo pattern (arrows). An enlarged pre‐tracheal node with loss of normal architecture is present (curved arrow). Biopsy revealed lymphoma.
Figure 18
Figure 18
Transverse power Doppler ultrasound shows an ill‐defined, heterogeneous hypoechoic lesion (arrows) involving most of the right lobe of thyroid. Increased vascularity, mainly peripheral, is demonstrated. Biopsy showed thyroid lymphoma.
Figure 19
Figure 19
Longitudinal power Doppler ultrasound shows an enlarged, elliptical, hypoechoic lymph node (arrows) with loss of normal architecture and abnormal increased peripheral vascularity.
See this image and copyright information in PMC

References

    1. Levy MJ, Howlett TA. Endocrine disease. In: Kumar P, Clark M, et al., editors. Kumar & Clark's clinical medicine. 8th edn. Spain: Saunders Elsevier; 2012. 959–71.
    1. Baumann GP, Jameson JL. Thyroid gland disorders. In: Longo DL, et al., editors. Harrison's manual of medicine, 18th edn. USA: McGraw Hill; 2013. 1116–26.
    1. Maitra A. The endocrine system. In: Kumar V, Abbas AK, Aster JC, et al., editors. Robbins and Cotran pathological basis of disease, 9th edn. Canada: Elsevier Saunders; 2015. 1091–2.
    1. Bahn RS, Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab 2011; 96(5): 1202–12. doi:10.1210/jc.2010-2583. - DOI - PubMed
    1. Ahuja AT, Lee YYP, Wong KT. Multinodular goiter. In: Ahuja AT, et al., editors. Diagnostic ultrasound: head and neck, Vol. II‐2. Altona, MB: Friesens; 2014. 22–5.

LinkOut - more resources