Toxic multinodular goiter echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Ultrasound

• Thyroid ultrasonography is the imaging method of choice in the diagnosis of multinodular goiter.
• Findings on an ultrasonography suggestive of multinodular goiter include more than one nodule including the non-palpable nodules cysts with varying echogenicity.
• Thyroid ultrasonography helps in assessment of size and number of nodules.
• Assessment of vascular characteristics of a thyroid nodule with Doppler helps in screening thyroid nodules for malignancy.

• Findings on ultrasonography suggestive of multinodular goiter benign nodules include
  • iso-hyperechoic nodules
  • surrounding hypoechoic halo
  • spongelike/honeycomb pattern
  • peripheral (eggshell) or coarse calcifications.
  • Doppler:
    • peripheral vessels are usually noted
    • the risk of malignancy is lower in nodules with a predominantly perinodular pattern

• Findings on ultrasonography suggestive of multinodular goiter malignant nodules include:
  • hypoechoic solid
  • intranodular blood flow.
  • Presence of microcalcifications
  • size greater than 10mm
  • Doppler:the risk of malignancy is higher in nodules with an exclusively central vascular pattern.

• It is important to screen for presence of malignant features (if any) and futher investigate with fine needle aspiration biopsy(FNAB) from the suspicious nodule.
• Thyroid ultrasonography can be used to guide FNAB. ultrasonography-guided FNAB may be preferable to palpation-guided FNAB.
• The possibility of measuring thyroid volume is another highly useful feature of ultrasonographic studies particularly after therapy with L-T4 or radioiodine ablation

• Mazzaglia concluded that surgeon-performed ultrasonographic examinations can be used to make necessary changes in surgical treatment and to avoid unnecessary surgery.