DR.

SANILA AHMED
CARCINOMA THYROID
Thyroid
Hormonal gland

Below Adams Apple

Produces T3, T4, and Calcitonin

Heart rate, metabolism, growth, blood
pressure

Feedback Mechanism
Types
Papillary Carcinoma
80%
Follicular Carcinoma
15%
Medullary Carcinoma
3%
Anaplastic Carcinoma
Risk Factors
Radiation
High dose x-rays or radioactive fallout
Family History
Goiters or Colon Growths
Mutated RET gene
Gender
Females
Iodine Levels
Seafood/Shellfish Consumption
NORMAL ANATOMY
THE NORMAL THROID GLAND IS LOCATED IN THE ANTERIOR
INFERIOR NECK.
ITS DIVIDED INTO TWO LOBES RESTING ON EITHER SIDE OF
TRACHEA, CONNECTED AT THEIR LOWER THIRD BY A THIN
ISTHMUS THAT CROSSES ANTERIOR TO THE TRACHEA.
IN THE ADULT, THE THYROID MEASURES 4 TO 6 CM IN LENGTH AND 1.3
TO 1.8 CM IN ANTEROPOSTERIOR AND TRANSVERSE DIAMETER.
THE ISTHMUS MEASURES UP TO 3 MM IN THICKNESS.
THYROMEGALYIS PRESENT WHENEVER THE TRANSVERSE OR
ANTEROPOSTERIOR DIAMETER EXCEEDS 2 CM OR WHEN PARENCHYMA
EXTENDS ANTERIOR TO CAROTIDS.
THE NORMAL THYROID IS VERY HOMOGENEOUS
AND HYPERECHOIC WHEN COMPARED WITH
THE ADJECENT MUSCLES.
SCATTERED READIALY DETECTABLE INTERNAL
VESSELS.
LOBES LESS THAN 2 CM ANTEROPOSTERIOR
AND TRANSVERSE.
ISTHMUS LESS 4 MM
CONT.
Hypoplasia
Aplasia
Ectopia: Ectopic thyroid tissue is most commonly
seen in a midline suprahyoid position between the
foramen cecum of the tongue and epiglottis, other
sites are sublingual, paralaryngeal, intratracheal
and infrasternal.
CONGENITAL
ANOMALIES
Thyroid nodules are extremely common and are he most
common indication for thyroid ultrasound.
Sonography detects nodules in approximately 40% of
patients who are scanned for other reasons.
Despite the high prevalence of thyroid nodules, the
percentage of thyroid malignancy is very low (2% to 4%).
In 80% of patients, thyroid hyperplasia is idiopathic or
related to iodine deficiency, familial cause or
medications.
CARCINOMA THYROID AND
NODULES
An enlarged, hyperplastic gland is called Goiter.
Male to female ratio is 1:3.
When hyperplasia progress to nodule formation, the
pathologic designation of the nodules may be
hyperplastic, adenomatous or colloid.
Nodular hyperplasia is the most common cause for
thyroid nodules.
GOITER
Thyroid adenoma. 67-year-old woman presenting with a
goiter. PA (A) and lateral (B) films show an oval mass in the superior part of
the middle mediastinum with displacement of the trachea forward and to
the right. Diagnosis confirmed by surgery.
COMMON SONOGRAPHIC APPEARANCES OF NODULES.
They very frequently have cystic components.
When nodules are small, the cyst components are also very small.
As the nodules enlarge, the cystic spaces also enlarge associated with
multiple internal septations and mural nodules.
The echogenicity of nodule of nodules hyperplasia is variable and may be
hypoechoic, isoechoic, or hyperechoic compared with normal
parenchyma.
SONOGRAPHIC
APPEARANCES
Accounts for 5% to 10% of thyroid nodules.
They typically solid and range from hypoechoic
to hyperechoic.
Well defined cystic spaces seen.
Well marginated and a hypoechoic halo is often
present.
Distinguished from follicular cancer on the
basis of vascular and capsular invasion.
BENIGN FOLLICULAR ADENOMAS
The most common and accounts for more 75% of cancers, younger than age 40
years and women.
Lymphatic dissemination is much common than hematogenous spread.
Prognosis is excellent with survival of 90% to 95% at 20 years.
Lymph node metastasis is common.
Distant metastasis is rare.
Microcarcinoma, a variant of the disease, is a sclerosing carcinoma less than 1 cm
and presents as large metastasis to the cervical nodes.
Papillary ca are typically hypoechoic and entirely solid.
Microcacification in psammoma bodies is common.
Cystic degenerative areas in lymph nodes are also very typical of papillary CA.
PAPILLARY
CARCINOMA
(A) Transverse ultrasound scan of the lower pole of the right
lobe of the thyroid with a small hypoechoic mass (arrow). There is an adjacent
level four nodal metastasis which is larger than the primary papillary
cancer and shows cystic change and abnormal vascularity (B).
Accounts for 10% thyroid cancers, common in women in 6
th

decades of life.
Divided into
MINIMALLY AND WIDELY INVASIVE FORMS.
Hematogenous spread is common especially to bone, brain, lung
and liver.
Metastasis to neck nodes is distinctly rare.
Distant metastasis is seen in 20% to 40% cases of widely invasive
variant and 5% to 10% cases of minimally invasive variant.
No microcalcification is seen.
FOLLICAL CARCINOMA
Fig.Abnormal partially cystic mass within the thyroid in another
patient with abnormal vascularity proved to be a papillary carcinoma.
Accounts for 5% of cancers.
Derived from parafollicular cells (C CELLS) that secrete
calcitonin.
Has more aggressive behavior than the differentiated
carcinomas, and does not respond to chemotherapy or
radiotherapy.
On sonography it appears as hypoechic, solid mass.
Microcalcification is common as seen in papillary CA.
MEDULLARY CARCINOMA
Accounts for less than 5% of thyroid
carcinomas.
Rarely seen in patients younger than 60 years of
age.
Has a dismal prognosis (5-years mortality of
greater than 95%)
Usually appears as a large, solid, hypoechoic
mass.
Local invasion of adjacent structure is common
at the time of presentation.
ANAPLASTIC CARCINOMA

Accounts for less than 5% of thyroid cancers.
Occurs as either a manifestation of generalized
lymphoma or as primary abnormality.
Women are affected more often than man.
Generally presents as a rapidly growing mass.
On sonography, it is usually a large, solid, hypoechoic
mass that infiltrates much of the thyroid parenchyma.
THYROID LYMPHOMA
(A) Longitudinal scan through the left lobe of the thyroid in a
patient known to have Hashimoto's thyroiditis reveals a loose heterogeneous
echotexture with abnormal colour flow. There are enlarged neck
nodes (B), again with abnormal colour flow in this patient who has developed
lymphoma
1- Simple cyst.
2- Cystic components are very common in nodular hyperplasia, may be
very small and require high- resolution probe to detect.
3- Echogenicity greater than or equal to normal thyroid.
4- Peripheral hypoechoic halo, when thin and regular.
5- well defined margins.
6- Peripheral eggshell calcification.
7- Multiple nodules.
SONOGRAPHIC FINDINGS OF
BENIGHN DISEASE
Fig. (A) A solid nodule seen within the thyroid. (B) Colour flow is
seen around the periphery of this benign nodule.
1- Entirely solid with no cystic elements.
2- Hypoechoic to normal thyroid.
3- Microcalcification
4- Thick peripheral hypoechoic halo.
5- Associated lymph nodes that appear malignant, especially if the nodes
contain microcalcification or cystic areas of necrosis.
SONOGRAPHIC FINDINGS OF
MALIGNANT DISEASE

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