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Thyroid

SUBJECT: Thyroid Ultrasound Exam

SECTION: Radiology Ultrasound

ORIGINATOR: Deborah L. Richert, BSVT, RDMS, RVT

REVISED DATE: August 29, 2015

Scheduling: One every half hour.

Prep: None.

Equipment: Ultrasound unit with at least a 5 MHz liner or curved linear transducer. It may be necessary to have a unit with a 7.5 MHz or higher transducer.

Exam Protocol: With ultrasound the thyroid gland and adjacent soft tissues of the neck will be thoroughly evaluated for masses, enlarged and/or abnormal lymph nodes (see below), thrombosed veins, or any other incidentally detected abnormalities.Documentation: Even though only specific images are documented, all soft tissues of the neck will be scanned in detail. The following images will represent the thyroid ultrasound exam (additional images may be necessary for proper documentation).

Documentation: Even though only specific images are documented, all soft tissues of the neck will be scanned in detail. The following images will represent the thyroid ultrasound exam (additional images may be necessary for proper documentation).

  • Image the right lobe of the thyroid transversely from superior to inferior (at least three images – upper, mid, lower – should be obtained). As thyroid nodules are seen measure the nodule in the transverse orientation first, then immediately measure the nodule in the longitudinal orientation. Use a split screen format when measuring thyroid nodule volume. A color Doppler image should also be obtained of each thyroid nodule. Continue imaging the thyroid transversely until completely evaluated. The maximum transverse measurement of the right lobe should be obtained.
  • Three representative longitudinal images of right lobe of thyroid: medial, mid, lateral (one with maximum length and AP measurements).
  • Transverse image of thyroid isthmus.
  • Image the left lobe of the thyroid transversely from superior to inferior (at least three images – upper, mid, lower – should be obtained). As thyroid nodules are seen measure the nodule in the transverse orientation first, then immediately measure the nodule in the longitudinal orientation. Continue imaging the thyroid transversely until completely evaluated. The maximum transverse measurement of the left lobe should be obtained.
  • Three representative longitudinal images of left lobe or thyroid: medial, mid, lateral (one with maximum length and AP measurements).
  • Transverse color Doppler image of the entire thyroid gland.
  • Longitudinal image of the RT lobe of the thyroid.
  • Longitudinal image of the LT lobe of the thyroid.
  • When multiple thyroid nodules are seen cineclips should be obtained in the axial/transverse plane of each thyroid lobe.

When evaluating lymph nodes adjacent to the thyroid be aware of the following: nodes that are round (instead of oblong), have focal bulges, or in which the normal hilum is replaced are suspicious lymph nodes. Abnormal lymph nodes should be measured in 3 dimensions: longitudinal, transverse, and AP. Note should be made of the location of the lymph node in relation to the thyroid gland.

Thyroid nodules need to be evaluated for the following characteristics. Please refer to the chart below to determine which nodules to evaluate. Specific isolated nodules should be measured rather than attempting to measure each nodule in a multi-nodular goiter.

  1. Size (in 3 dimensions) and volume estimates of each major nodule.
  2. Whether microcalcifications or macrocalcifications are present.
  3. Comment on the margins: halo, irregular, etc.
  4. Character: solid, cystic, mixed, mural.
  5. Echogenicity: hypo, iso, hyper.
  6. Vascularity: increased, normal, decreased.
  7. Background echotexture of gland, if heterogeneous.

ATA/SRU Guidelines for FNA of Thyroid Nodules

  • High Risk History: >5mm w/suspicious features
  • Microcalcifications: >1 cm
  • Solid Nodule and Hypoechoic: >1 cm
  • Solid Nodule and Hyper/Isoechoic: >1.5 cm
  • Mixed Cystic and Solid w/suspicious features: >1.5 cm
  • Mixed Cystic and Solid w/o suspicious features: >2 cm
  • Substantial Interval Growth: >50% increase in volume

*Suspicious features include microcalcifications, hypoechogenicity, irregular margins, internal vascularity, absent halo, taller than wide.

*High risk history includes the following: Personal history of thyroid CA, h/o H/N XRT, immediate family member with thyroid CA, hot nodule on PET, h/o MEN syndrome.

View the Thyroid US worksheet

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