Nodular or Colloid Goiter, Hyperplasia, and Cysts
These thyroid nodules are often described as hyperplastic, adenomatous, or colloid. Most cystic thyroid lesions are hyperplastic nodules that have undergone extensive liquefactive degeneration. The common features of a nodular goiter are multinodular inhomogeneous, well-circumscribed solid, semi-solid or mostly cystic tumors. Some are hyperechoic compared with the echogenicity of the normal thyroid tissue, some are isoechoic, and still others hypoechoic. The hyper- and isoechoic nodules are often partially circumscribed by a thin hypoechoic halo. The nodules may contain coarse calcifications within the tumor, or peripheral “eggshell” calcifications. The cystic areas are often purely anechoic, but they may also be hypoechoic or show fluid-fluid levels due to intracystic bleeding, often with avascular internal debris. Many, even tiny cysts, contain small, strongly hyperechoic foci, often with “comet tail” artifacts. These foci represent crystallized colloid. Some cysts have intracystic avascular septae and/or papillary solid tissue protruding from the wall. Some cystic nodules have a spongy or honeycomb-like appearance. The vascularity varies a lot when evaluated on color Doppler imaging. Sometimes only spreading, faint vascularity is observed throughout the nodule, but often there is strong vascularity inside the nodule combined with a distinct peripheral border flow.
KeywordsPapillary Thyroid Carcinoma Left Lobe Nodular Goiter Follicular Adenoma Follicular Tumor
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