Current State of the Problem of Thyroid Diseases: Principles and Technology of Thyroid Ultrasound



Iodine deficiency in endemic regions and high incidence of thyroid disorders remain important social and medical problems. The diseases of the thyroid gland rank second among all endocrine pathology in terms of prevalence. They are registered in 8–20% of the adult population of the world. The number exceeds 50% in endemic regions. Thyroid cancer accounts for 1–3% of all malignant tumors. Recent studies demonstrate the increase in the incidence of thyroid diseases inclusive with malignant neoplasms in virtually all countries. Ultrasound is the leading imaging modality for thyroid diseases. Modern ultrasound scanners are sensitive enough to differentiate thyroid lesions of 1 mm in size. Sonography can be utilized as a screening method for thyroid diseases. Patients with thyroid abnormalities are subject to further qualified in-depth study. Modern multiparametric thyroid ultrasound is based on grayscale imaging and its derivatives (tissue harmonics, etc.), noninvasive assessment of vascularity (color and power Doppler imaging, spectral pulsed-wave Doppler, B-flow, etc.), assessment of tissue elasticity (ultrasound compression and shear wave elastography), contrast-enhanced ultrasound (invasive assessment of vascularity), postprocessing, and reconstruction (3D/4D, panoramic scan, multislice view, etc.). The study confers data on the location, dimensions, volume, margins, shape, echodensity, echostructure, elasticity, blood vessels of the thyroid parenchyma, and thyroid abnormalities.


  1. 1.
    Davydov MI, editor. Thyroid cancer. Oncology. Clinical recommendations. Moscow: Izdatyelskaya gruppa RONTS; 2015. (Book in Russian).Google Scholar
  2. 2.
    Fadeev VV. Nodular lesions of the thyroid gland: international algorithms and domestic clinical practice. Vrach. 2002;7:12–6. (Article in Russian).Google Scholar
  3. 3.
    Kotlyarov PM, Kharchenko VP, Alexandrov YK, et al. Ultrasound diagnosis of the diseases of the thyroid gland. Moscow: Vidar-M; 2009. (Book in Russian).Google Scholar
  4. 4.
    Schenke S, Zimny M. Combination of sonoelastography and TIRADS for the diagnostic assessment of thyroid nodules. Ultrasound Med Biol. 2018;44(3):575–83.CrossRefGoogle Scholar
  5. 5.
    Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean society of thyroid radiology consensus statement and recommendations. Korean J Radiol. 2016;17(3):370–95.CrossRefGoogle Scholar
  6. 6.
    Tessler FN, Middleton WD, Grant EG, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. J Am Coll Radiol. 2017;14(5):587–95.CrossRefGoogle Scholar
  7. 7.
    Baskin HJ, Duick DS, Levine RA, editors. Thyroid ultrasound and ultrasound-guided FNA. Berlin: Springer; 2013.Google Scholar
  8. 8.
    Biersack HJ, Grünwald F. Thyroid cancer. Berlin: Springer; 2005.CrossRefGoogle Scholar
  9. 9.
    Choi YM, Kim WG, Kwon H, et al. Changes in standardized mortality rates from thyroid cancer in Korea between 1985 and 2015: analysis of Korean national data. Cancer. 2017;123(24):4808–14.CrossRefGoogle Scholar
  10. 10.
    Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54.CrossRefGoogle Scholar
  11. 11.
    Paschke R, Cantara S, Crescenzi A, et al. European Thyroid Association Guidelines regarding thyroid nodule molecular fine needle aspiration cytology diagnostics. Eur Thyroid J. 2017;6(3):115–29.CrossRefGoogle Scholar
  12. 12.
    Sofferman RA, Ahuja AT, editors. Ultrasound of the thyroid and parathyroid glands. Berlin: Springer; 2012.Google Scholar
  13. 13.
    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRefGoogle Scholar
  14. 14.
    Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiate d thyroid cancer. Thyroid. 2016;26:1–133.CrossRefGoogle Scholar
  15. 15.
    Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid. 2013;23(7):885–91.CrossRefGoogle Scholar
  16. 16.
    Kaprin AD, Starinsky VV, Petrova GV, editors. The state of oncological care for the population of Russia in 2017. Moscow: P.A.Hertsen Moscow Oncology Research Center—Branch of Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Healthcare of the Russian Federation; 2018. (Book in Russian).Google Scholar
  17. 17.
    Duick DS, Levine RA, Lupo MA, editors. Thyroid and parathyroid ultrasound and ultrasound-guided FNA. Berlin: Springer; 2018.Google Scholar
  18. 18.
    Mitkov VV, Ivanishina TV, Mitkova MD. Shear wave elastography in multiparametric ultrasound diagnosis of thyroid cancer. Ultrazvukovaya i funkcionalnaya diagnostika. 2016;1:13–28. (Article in Russian).Google Scholar
  19. 19.
    Du J, Bai X, Lu Y, et al. Diagnostic efficacy of ultrasonographic characteristics of thyroid carcinoma in predicting cervical lymph node metastasis. Ultrasound Med Biol. 2016;42(1):68–74.CrossRefGoogle Scholar
  20. 20.
    Rumyantsev PO, Ilyin AA, Rumyantseva UV, Sayenko VA. Thyroid cancer, modern approaches to diagnosis and treatment. Moscow: GEOTAR-Media; 2009. (Book in Russian).Google Scholar
  21. 21.
    Sencha AN. Ultrasonic visualization of malignant tumors of the thyroid gland. Ultrazvukovaya i funkcionalnaya diagnostika. 2008;2:20–9. (Article in Russian).Google Scholar
  22. 22.
    Howry DH, Holmes JH, Cushman CR, Posakony GJ. Ultrasonic visualization of living organs and tissues; with observations on some disease processes. Geriatrics. 1955;10(3):123–8.PubMedGoogle Scholar
  23. 23.
    Fujimoto Y, Oka A, Omoto R, Hirose M. Ultrasound scanning of the thyroid gland as a new diagnostic approach. Ultrasonics. 1967;5:177.CrossRefGoogle Scholar
  24. 24.
    Blum M, Weiss B, Hernberg J. Evaluation of thyroid nodules by A-mode echography. Radiology. 1971;101:651–6.CrossRefGoogle Scholar
  25. 25.
    World Health Organization. Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. 2nd ed. Geneva: WHO; 2002. Available from: NHD_01.1/en/.Google Scholar
  26. 26.
    Cui Y, Zhang Z, Li S, et al. Diagnosis and surgical management for retrosternal thyroid mass. Chin Med Sci J. 2002;17(3):173–7.PubMedGoogle Scholar
  27. 27.
    Sciume C, Geraci G, Pisello F. Substernal goitre. Personal experience. Ann Ital Chir. 2005;76(6):517–21.PubMedGoogle Scholar
  28. 28.
    Vlasov PV. Imaging diagnosis of the diseases of the chest. Moscow: Vidar; 2006. (Book in Russian).Google Scholar
  29. 29.
    Pinsky SV, Kalinin AP, Beloborodov VA. Diagnosis of diseases of the thyroid gland. Moscow: Medicine; 2005. (Book in Russian).Google Scholar
  30. 30.
    Ayache S, Mardyla N, Tramier B, Strunski V. Clinical signs and correlation with radiological extent in a series of 117 retrosternal goitre. Rev Laryngol Otol Rhinol (Bord). 2006;127(4):229–37.Google Scholar
  31. 31.
    Mackle T, Meaney J, Timon C. Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross-sectional imaging findings. J Laryngol Otol. 2006;26:1–4.Google Scholar
  32. 32.
    Kazakevich VI. Possibilities of mediastinal ultrasound in substernal spreading of thyroid tumors. Sonoace Int. 2007;16:58–65.. Article in RussianGoogle Scholar
  33. 33.
    Pishchik VG. Mediastinal neoplasms: the principles of differential diagnosis and surgical treatment. PhD thesis, S-Petersburg. 2008. (Book in Russian).Google Scholar
  34. 34.
    Ignjatovic M. Intrathoracic goiter. Vojnosanit Pregl. 2001;58(1):47–63.PubMedGoogle Scholar
  35. 35.
    Belashkin II, Kulikova AD, Kochetkov AV, Kulikov MP. The value of the second tissue harmonic in the diagnosis of colloid nodes of the thyroid gland. In: Reports of the 4th Congress of the Russian Association of Specialists in ultrasound diagnostics in medicine. Moscow: 2003. p. 209. (Article in Russian).Google Scholar
  36. 36.
    Khadra H, Bakeer M, Hauch A, et al. Is vascular flow a predictor of malignant thyroid nodules? A meta-analysis. Gland Surg. 2016;5(6):576–82.CrossRefGoogle Scholar
  37. 37.
    Kahaly GJ, Bartalenab L, Hegedüs L, et al. 2018 European Thyroid Association Guideline for the management of Graves’ hyperthyroidism. Eur Thyroid J. 2018;7:167–86.CrossRefGoogle Scholar
  38. 38.
    Joish UK, Kavitha Y, Reddy RH, et al. Doppler indices of superior thyroid artery in clinically euthyroid adults. Indian J Radiol Imaging. 2018;28(1):10–3.CrossRefGoogle Scholar
  39. 39.
    Palaniappan MK, Aiyappan SK, Ranga U. Role of gray scale, color Doppler and spectral Doppler in differentiation between malignant and benign thyroid nodules. J Clin Diagn Res. 2016;10(8):TC01–6.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Ivanishina TV. Diagnostic possibilities of shear wave elastography in thyroid disease. PhD thesis, Moscow: 2017. (Book in Russian).Google Scholar
  41. 41.
    Lindop JE, Treece GM, Gee AH, Prager RW. 3D elastography using freehand ultrasound. J Ultrasound Med Biol. 2006;32(4):529–45.CrossRefGoogle Scholar
  42. 42.
    Mitkov VV, Ivanishina TV, Mitkova MD. Ultrasound examination of the unchanged thyroid gland with the use of shear wave elastography technology. Ultrazvukovaya i funkcionalnaya diagnostika. 2014;6:13–20. (Article in Russian).Google Scholar
  43. 43.
    Ophir J, Cespedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–34.CrossRefGoogle Scholar
  44. 44.
    Sencha AN, Mogutov MS, Patrunov YN, et al. Quantitative and qualitative parameters of ultrasonic elastography in the diagnosis of thyroid cancer. Ultrazvukovaya I funkcionalnaya diagnostika. 2013;5:85–98. (Article in Russian).Google Scholar
  45. 45.
    Tanaka K, Fukunari N, Igarashi T, et al. Evaluation of thyroid malignant tumor using real – team tissue elastography. Ultrasound Med Biol. 2006;32(5):93.Google Scholar
  46. 46.
    Zubarev AR, Fedorova VN, Demidova AK, et al. Ultrasonic elastography as a new step in the differential diagnosis of thyroid nodules: a literature review and preliminary clinical data. Medicinskaya Vizualizaciya. 2010;1:11–6. (Article in Russian)Google Scholar
  47. 47.
    Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.CrossRefGoogle Scholar
  48. 48.
    Rago T, Vitti P. Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:913–28.CrossRefGoogle Scholar
  49. 49.
    Park SH, Kim SJ, Kim E, et al. Interobserver agreement in assessing the sonographic and elastographic features of malignant thyroid nodules. AJR. 2009;193(5):W416–23.CrossRefGoogle Scholar
  50. 50.
    Cantisani V, Grazhdani H, Ricci P, et al. Q-elastosonography of solid thyroid nodules: assessment of diagnostic efficacy and interobserver variability in a large patient cohort. Eur Radiol. 2014;24:143–50.CrossRefGoogle Scholar
  51. 51.
    Fukunari N, Arai K, Naakamura A, et al. Clinical evaluation of elastography for the differential diagnosis of thyroid follicular tumors. Abstracts from the 12th Congress of World Federation for Ultrasound in Medicine and Biology. J Ultrasound Med Biol. 2009;35(S8):230.CrossRefGoogle Scholar
  52. 52.
    Vasiliev DA, Kostromina EV, ZA-G R, et al. Ways to improve the diagnostic significance of sonoelastography in differential diagnosis of thyroid nodules. Clin Exp Thyroid. 2014;10(1):38–43. (Article in Russian).CrossRefGoogle Scholar
  53. 53.
    Wang Y, Dan HJ, Dan HY, et al. Differential diagnosis of small single solid thyroid nodules using realtime ultrasound elastography. J Int Med Res. 2010;38(2):466–72.CrossRefGoogle Scholar
  54. 54.
    Garra BS. Tissue elasticity imaging using ultrasound. Appl Radiol. 2011;2:24–30.Google Scholar
  55. 55.
    Sencha AN, Mogutov MS, Sergeeva ED, Shmelev DM. Sonoelastografiya and the newest technologies of ultrasonic research of a cancer of a thyroid gland. Moscow: Vidar; 2010. (Book in Russian).Google Scholar
  56. 56.
    Borsukov AV, Morozova TG, Kovalev AV, et al. Standardized technique of compression thyroid ultrasound of the thyroid gland. Endocr Surg. 2014;1:55–61. (Article in Russian).CrossRefGoogle Scholar
  57. 57.
    Calvete AC, Mestre JD, Gonzalez JM, et al. Acoustic radiation force impulse imaging for evaluation of the thyroid gland. J Ultrasound Med. 2014;33(6):1031–40.CrossRefGoogle Scholar
  58. 58.
    Friedrich-Rust M, Sperber A, Holzer K, et al. Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes. 2010;118:602–9.CrossRefGoogle Scholar
  59. 59.
    Monpeyssen H, Tramalloni J, Poiree S, et al. Elastography of the thyroid. Diagn Interv Imaging. 2013;94(5):535–44.CrossRefGoogle Scholar
  60. 60.
    Pomortsev AV, Gudkov GV, Degtyareva YS, et al. Possibilities of shear wave elastography in differential diagnostics of focal thyroid pathology. Radiat Diagn Ther. 2011;3:60–6. (Article in Russian).Google Scholar
  61. 61.
    Sebag F, Vaillant-Lombard J, Berbis J, et al. Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab. 2010;95(12):5281–8.CrossRefGoogle Scholar
  62. 62.
    Sencha AN. Ultrasound diagnostics. Surface-located organs. Moscow: Vidar M Publishing House; 2015. (Book in Russian).Google Scholar
  63. 63.
    Osipov LV. Ultrasound diagnostic devices. Modes, methods and techniques. Moscow: Izomed; 2011. (Book in Russian).Google Scholar
  64. 64.
    Magri F, Chytiris S, Capelli V, et al. Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis. Clin Endocrinol. 2012;76(1):137–41.CrossRefGoogle Scholar
  65. 65.
    Ma BY, Jin Y, Suntdar PS, et al. Contrast-enhanced ultrasonography findings for papillary thyroid carcinoma and its pathological bases. Sichuan Da Xue Xue Bao Yi Xue Ban. 2014;45(6):997–1000.PubMedGoogle Scholar
  66. 66.
    Sencha AN, Mogutov MS, Patrunov YN, et al. Ultrasound with contrast agents. Moscow: Vidar; 2016. (Book in Russian).Google Scholar
  67. 67.
    Sencha EA. Ultrasound examination with contrast enhancement in the diagnosis of thyroid tumors. REJR. 2017;7(3):44–52. (Article in Russian).CrossRefGoogle Scholar
  68. 68.
    Zhang B, Jiang YX, Liu JB, et al. Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid. 2010;20(1):51–7.CrossRefGoogle Scholar
  69. 69.
    Zhang Y, Zhou P, Tian SM, et al. Usefulness of combined use of contrast-enhanced ultrasound and TI-RADS classification for the differentiation of benign from malignant lesions of thyroid nodules. Eur Radiol. 2017;27:1527–36.CrossRefGoogle Scholar
  70. 70.
    Zhao RN, Zhang B, Yang X, et al. Diagnostic value of contrast enhanced ultrasound of thyroid nodules coexisting with Hashimoto’s thyroiditis. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015;37(1):66–70.PubMedGoogle Scholar
  71. 71.
    Gramiak R, Shah P, Cramer D. Ultrasound cardiography: contrast studies in anatomy and function. Radiology. 1969;92:939.CrossRefGoogle Scholar
  72. 72.
    Spiezia S, Farina R, Cerbone G. Analysis of time/intensity enhancement curves after echocontrast agents injection in thyroid nodules evaluation: preliminary report. In: Ultrasound in medicine and biology 26(S2). Abstracts from the 9th Congress of WFUMB. Florence. Italy. 2000; p. A181.Google Scholar
  73. 73.
    Schleder S, Janke M, Agha A, et al. Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 2015;61(1):13–22.CrossRefGoogle Scholar
  74. 74.
    Sencha EA, Sencha AN, Penyaeva EI, et al. The use of quantitative analysis of ultrasound with contrast enhancement in the differential diagnosis of focal changes in the thyroid gland. Ultrazvukovaya i funkcionalnaya diagnostika. 2018;2:12–26. (Article in Russian).Google Scholar
  75. 75.
    Yuan Z, Quan J, Yunxiao Z, et al. Contrast-enhanced ultrasound in the diagnosis of solitary thyroid nodules. J Cancer Res Ther. 2015;11:41–5.CrossRefGoogle Scholar
  76. 76.
    Turtulici G, Orlandi D, Fabbro E, et al. Contrast-enhanced ultrasound (CEUS) quantitative evaluation of histologically proven thyroid nodules. In: Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011, Chicago IL. 2011.
  77. 77.
    Jiang J, Huang L, Zhang H, et al. Contrast-enhanced sonography of thyroid nodules. J Clin Ultrasound. 2015;43(3):153–6.CrossRefGoogle Scholar
  78. 78.
    Sencha AN, Patrunov Yu N, Mogutov MS, et al. Thyroid cancer: US THI-RADS classification, ultrasound qualitative and quantitative elastography, contrast ultrasound. In: Collection of scientific papers “Nevsky Radiologichesky Forum-2015”. St. Petersburg: ELBI-SPb; 2015. pp. 605–8. (Book in Russian).Google Scholar
  79. 79.
    Yu D, Han Y, Chen T. Contrast-enhanced ultrasound for differentiation of benign and malignant thyroid lesions: meta-analysis. Otolaryngol Head Neck Surg. 2014;151(6):909–15.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Visual and Functional DiagnosticsNational Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian FederationMoscowRussia
  2. 2.Department of Ultrasound DiagnosticsCenter for Radiological Diagnostics of Non-State Healthcare Institution Yaroslavl Railway Clinic of JSC “Russian Railways”YaroslavlRussia
  3. 3.Academic Council of National Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian FederationMoscowRussia
  4. 4.Department for Internal Diseases PropaedeuticCourse of Diagnostic Radiology of Medical Faculty of Federal State Budget Educational Institution of Higher Education “I. N. Ulianov Chuvash State University”CheboksaryRussia
  5. 5.Department of Ultrasound DiagnosticsKazan State Medical Academy – Branch Campus of the Federal State Budget Educational Institution of Further Professional Education, “Russian Medical Academy of Continuing Professional Education” of the Ministry of Healthcare of the Russian FederationKazanRussia
  6. 6.Department of Gynecological EndocrinologyNational Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian FederationMoscowRussia

Personalised recommendations