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Jennifer Pittman

Thyroid Written Assignment

Directions: Students should complete each set of questions prior to the due date on the syllabus.
The assignment will assist students in identifying main topics to be learned. It is extremely
important that students understand that a more thorough discussion will take place during class
and laboratory sessions. In order to learn the material in depth students are encouraged to read
their textbook and take notes during class and laboratory meetings.

Normal Anatomy and Sonographic Technique

1. Why is a high frequency linear array transducers preferred for imaging the thyroid?
High-frequency transducers will provide penetration, high-definition images, and
resolution. Linear array transducers are used because of the wide near field of view
and capability to combine high-frequency gray-scale and color Doppler images.
2. Explain two advanced imaging techniques for evaluating the thyroid.
Contrast-enhanced sonography: Uses second-generation contrast agents and very low
mechanical index. It is useful for diagnosis of select cases of nodular disease.
Sonoelastography: based on the principle that when body tissues are compressed
softer parts will deform more easily. The amount of displacement at various depths is
determined by signals reflected by tissue before and after they are compressed and
corresponding strains are calculated from the displacements and displayed visually.
3. What neck muscle may be seen both anterior and lateral to the thyroid?
Sternocleidomastoid muscle
4. What is the purpose for scanning laterally and inferiorly to the thyroid?
It should be scanned laterally to include the region of the carotid artery and
jugular vein in order to identify enlarged jugular lymph nodes.
Inferiorly to define any pathologic supraclavicular lymph nodes.
5. Which measurement technique when used alone can determine thyroid enlargement?
AP diameter
6. What is volume measurement of the thyroid?
In neonates it ranges from 0.40 to 1.40 mL, increasing by 1.0 to 1.3 mL for each
10 kg of body weight.
In adults the normal volume is 10 to 11 +- 3 mL
7. How does the size of the thyroid vary with patient size?

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In tall patients the lateral lobes have a longitudinally elongated shape on sagittal
scans. Shorter individuals have a more oval gland.

8. What is the relationship of the velocity of blood flow in the thyroid compared to other
structures found in the body?
The peak systolic velocities reach 20 to 40 cm/sec in the major thyroid arteries
and 15 to 30 cm/sec in the intraparenchymal arteries. The thyroid has the highest
velocities found in blood vessels supplying superficial organs.
1. What is the difference between aplasia, hypoplasia, and ectopia of the thyroid?
Aplasia- failure of the thyroid to develop
Hypoplasia- underdevelopment or reduced size
Ectopia- thyroid is not located in its normal area
2. What is a nodule?
Thyroid nodules are lumps which commonly arise within an otherwise normal
thyroid gland. They indicate a thyroid neoplasm, but only a small percentage of
these are thyroid cancers.
3. What is an adenoma?
Many are solitary, but may also develop as a part of a multinodular process. Most
adenomas result in no thyroid dysfunction; a small amount hyperfunction,
develop autonomy and may cause thyrotoxicosis.
4. What is a goiter?
When hyperplasia or enlargement leads to an overall increase in size or volume of
the gland.
5. If a thyroid nodule is identified, what role does sonography play?
Sonography will determine the location of palpable neck mass, characterize
between benign or malignant nodule features, detect occult nodule in pt with
history of head and neck irradiation or MEN II syndrome, determine extent of
known thyroid malignancy, detect residual, recurrent, or metastatic carcinoma,
and guide fine-needle aspiration of thyroid nodule or cervical lymph nodes.
6. Compare and contrast the sonographic features of the pathologies seen in figures 18-8,
18-9, 18-10, and 18-11.
The pathologies in 18-8, 18-9, 18-10, and 18-11 are all round in shape and have
well defined borders. However, they all have different appearances. 18-8 is a
homogeneous nodule with a thin and uniform hypoechoic halo. 18-9 has a

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honeycomb like appearance with large and small anechoic cystic areas within it.
18-10 is an anechoic cystic area with small echogenic foci seen as internal echoes.
18-11 has a hypoechoic appearance with echogenic coarse peripheral
calcifications or eggshell calcifications.
7. Are the pathologies in figures 18-8, 18-9, 18-10, and 18-11 the same? Why do they look
The pathologies seen in figures 18-8, 18-91 18-10, and 18-11 are not the same.
Some of them are benign and some are malignant. They all have different
appearances. 18-8 is a homogeneous nodule with a thin and uniform hypoechoic
halo. 18-9 has a honeycomb like appearance with large and small anechoic cystic
areas within it. 18-10 is an anechoic cystic area with small echogenic foci seen as
internal echoes. 18-11 has a hypoechoic appearance with echogenic coarse
peripheral calcifications or eggshell calcifications.
8. Are there different types of adenomas? Can you tell the difference sonographically? If no,
how is the difference determined?
There is more than one type of adenomas. The cytological features are normally
indistinguishable Sonographically they appear as solid masses either hyperechoic,
hypoechoic, or isoechoic. The vascular appearance is normally the same with
hyperfunctioning and poorly functioning adenomas. Needle biopsy is not reliable
to determine the difference, so normally they are just surgically removed.
9. Is an adenoma a type of nodular disease? Can the terms possibly be used
interchangeably? How is the best way to describe a mass seen on the thyroid---as a
nodule, an adenoma, or a mass?
Adenomas represent 5 to 10% of nodular diseases. Because nodules can be either
benign or malignant the words can be used interchangeably. When you are
describing an area seen in the thyroid nodule is the best way to describe it because
it is a general term.
10. How many types of thyroid malignancies are listed in your book?
11. Identify at least one distinct difference sonographically or clinically among all
malignancies listed in the chapter.
Papillary carcinoma of the thyroid peaks in both the third and seventh decade of
life. Papillary microcarcinoma measures 1 cm or less in diameter and can be seen
as a small hyperechoic patch. Follicular carcinoma is hard to distinguish, but
rarely seen to differentiate is irregular tumor margins and a thick irregular
hypoechoic halo. Medullary carcinoma is derived from the parafollicular cells, or
C cells, and typically secretes the hormone calcitonin. Anaplastic thyroid

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carcinoma cannot be adequately examined by ultrasound because of large size;
they are large hypoechoic masses that invade blood vessels and neck muscles.
Lymphomas typically present clinically as rapid growing masses that cause
symptoms such as dyspnea and dysphagia. Thyroid metastases are usually caused
from melanoma, breast, and renal cell carcinoma; are a result of hematogeneous
spread or less frequently a lymphatic route.
12. What are the four main sonographic features associated with benign thyroid nodules?
Wider than tall, sharp and well-defined margins, significant cystic component,
large and coarse calcifications.
13. What are the four main sonographic features associated with malignant thyroid nodules?
Taller than wide, thickened and interrupted peripheral calcifications, irregular and
poor-defined margins, marked hypoechogenecity.
14. Does Doppler clearly help differentiate between benign and malignant nodules?
Quantitative analysis of flow velocities is not accurate in differentiating benign
from malignant nodules, so the only Doppler that may be useful is the distribution
of vessels. Adenoma nodules can display peripheral vascularity and malignancies
can display internal vascularity. However, color Doppler is not reliable in
15. What is the sonographic difference between benign and malignant cervical lymph nodes?
Benign cervical lymph nodes normally have a slender, oval shape and often
exhibit central echogenic bands that represent a fatty hilum. Malignant cervical
lymph nodes are more often located in the lower third of the neck and are usually
rounder without an echogenic hilum.
16. What is thryoiditis? Are there different types?
Inflammatory disease of the thyroid. The different types include acute suppurative
thyroiditis, subacute granulomatous thyroiditis, and chronic lymphocytic
17. How does thyroiditis appear sonographically?
The sonographic appearance of thyroiditis may vary. Acute suppurative thyroiditis
can be seen when an abscess is seen as a poorly defined, hypoechoic
heterogeneous mass with internal debris, with or without septa and gas. Subacute
granulomatous thyroiditis will appear enlarged and hypoechoic, with normal or
decreased vascularity caused by diffuse edema of the gland, or the process may
appear as focal hypoechoic regions. Chronic lymphocytic thyroiditis can be seen
as diffuse, coarsened, parenchymal echotecture, and more hypoechoic than a
normal thyroid.

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18. Explain thyroid inferno.
Color Doppler demonstrating a hypervascular pattern. Spectral Doppler will show
peak systolic velocities exceeding 70 cm/sec, the highest velocity found in thyroid
19. What interventional procedures would a sonographer help assist with in cases of thyroid
Fine needle biopsy, ethanol injection, interstitial laser photocoagulation,
radiofrequency ablation, and percutaneous ethanol injections.
20. Is there a relationship between TSH and blood flow to the thyroid?
Hypervascularity occurs when hypothyroidism develops. It is related to the
stimulation from the associated high serum levels of TSH.