Thyroid nodule echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Ultrasound

Thyroid nodule assessment

Thyroid gland ultrasound is one of the first steps of the thyroid nodule diagnostic evaluation. In the case of multiple nodules presentation, all the nodules should be assessed for suspicious ultrasound characteristics.The important points that can be characterized with ultrasound include:

• Confirmation of the diagnosis of a thyroid nodule
• Assess the size of the nodule
• Determining the location of the nodule
• Determination of the shape of the nodule
• Evaluation of the composition
• Evaluation of the echogenicity
• Evaluation of the margins
• Presence of calcification
• Evaluation of the vascularity of the nodules
• Evaluation of the adjacent structures in the neck including the lymph nodes
• FNA decision making
  • Based on the size, vascularity, and shape

The following characteristics are more likely to be a malignant lesion:

• Shape that is taller than wide measured in the transverse dimension
• Hypoechogenicity
• Irregular margins
• Microcalcifications
• Absent halo

The following characteristics are more likely to be a benign lesion:

• Purely cystic nodule (< 2 % risk of malignancy)

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Spongiform appearance (99.7 % specific for benign thyroid nodule)

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FNA criteria based on ultrasound

Cervical lymph node assessment

The most important nodules that should be evaluated in a patient with thyroid nodule include anterior, central and lateral compartment cervical nodules. During sevical lymph node assessment, the following characteristic should have FNA evaluation for cytology and washout Tg measurement:

• Microcalcification withing the lymph node
• Cystic lymph nodes
• Peripheral vascularity
• Hyperechogenicity of the lymph node
• Round shape lymph node