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Pattern Recognition: Diffuse Thyroid Disease

  • Mark A. LupoEmail author
Chapter

Abstract

Diffuse enlargement of the thyroid gland is a common finding during both physical examination and during ultrasound evaluation. While chronic lymphocytic thyroiditis (CLT), Hashimoto’s thyroiditis, is the most common cause of goiter and hypothyroidism in countries with adequate iodine intake, thyroiditis refers to a diverse group of conditions caused by thyroid inflammation. The sonographic hallmark of thyroid autoimmunity is diffuse hypoechogenicity and heterogeneity, with multiple variants having been described. Understanding the various features of thyroiditis provides valuable clinical insight into the disease process. Moreover, pattern recognition of the various sonographic presentations of autoimmune diffuse thyroid disease is essential in determining if a focal abnormality represents a true nodule which may require fine-needle aspiration biopsy or is simply part of the inflammatory process. Doppler interrogation of the thyroid in a patient with thyrotoxicosis can often differentiate Graves’ disease from silent or subacute thyroiditis. Reactive appearing lymph nodes in the paratracheal and adjacent lateral neck regions are common in thyroiditis. Real-time imaging or the use of cine-clips is superior to static imaging in detecting diffuse thyroid disease and ideally is performed by the clinician caring for these patients. As such, this chapter includes electronic supplementary material (ESM).

Keywords

Thyroiditis Diffuse enlargement Ultrasound Hashimoto’s Graves’ Heterogeneity (heterogeneous) Pseudonodule Fibrosis Lymph node Hypoechoic Doppler Thyrotoxicosis Drug-induced thyroiditis Silent thyroiditis Heterogeneity Variability Hypoechogenicity 

Supplementary material

Video 16.1

Early Hashimoto’s (MP4 6952 kb)

Video 16.2

Pseudomicronodule’s (MP4 7181 kb)

Video 16.3

Profoundly hypoechoic (MP4 8659 kb)

Video 16.4

Developing fibrosis—LONG (MP4 8397 kb)

Video 16.5

Developing fibrosis—TRV (MP4 12,553 kb)

Video 16.6

Tubercle of Zuckerkandl (MP4 17,834 kb)

Video 16.7

Hyperechoic (MP4 17,692 kb)

Video 16.8

Fibrosis with speckling—LONG (MP4 9175 kb)

Video 16.9

Fibrosis with speckling—TRV (MP4 5830 kb)

Video 16.10

Paratracheal nodes (MP4 13,362 kb)

Video 16.11

Ectopic Hashimoto (MP4 14,885 kb)

Video 16.12

Pyrimidal lobe in Hashimoto (MP4 12,465 kb)

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Thyroid & Endocrine Center of FloridaFlorida State University, College of MedicineSarasotaUSA

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