Skip to main content

Thyroid ultrasound is an exquisitely sensitive technique for the detection of thyroid nodules and is able to image nodules as small as 2–3 mm. The prevalence of sonographically detected nodules that cannot be palpated is up to 50%–60% in individuals older than 60 (1). Therefore, the challenges confronting the clinician are the identification of those nodules that have a higher probability of being clinically relevant malignancies so that these can be targeted for fineneedle aspiration biopsy, and the recognition of those that may undergo sonographic surveillance. Furthermore, diffuse thyroid disorders, such as Graves’ disease and Hashimoto’s thyroiditis, image differently than the normal thyroid parenchyma, but it may be challenging to differentiate asymmetric involvement of the thyroid by one of these diffuse processes from a discrete thyroid nodule.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med 328(8):553–559

    Article  PubMed  CAS  Google Scholar 

  2. Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16(2):109–142

    Article  PubMed  Google Scholar 

  3. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi (2006) Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12(1):63–102

    Google Scholar 

  4. Marqusee E, Benson CB, Frates MC et al (2000) Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med 133(9):696–700

    PubMed  CAS  Google Scholar 

  5. Brander A, Viikinkoski P, Tuuhea J, Voutilainen L, Kivisaari L (1992) Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound 20(1):37–42

    Article  PubMed  CAS  Google Scholar 

  6. Tan GH, Gharib H, Reading CC (1995) Solitary thyroid nodule: comparison between palpation and ultrasonography. Arch Intern Med 155(22):2418–2423

    Article  PubMed  CAS  Google Scholar 

  7. Alexander EK, Heering JP, Benson CB et al (2002) Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87(11):4924–4927

    Article  PubMed  CAS  Google Scholar 

  8. Hall TL, Layfield LJ, Philippe A, Rosenthal DL (1989) Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer 63(4):718–725

    Article  PubMed  CAS  Google Scholar 

  9. Leenhardt L, Hejblum G, Franc B et al (1999) Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 84(1):24–28

    Article  PubMed  CAS  Google Scholar 

  10. Papini E, Guglielmi R, Bianchini A et al (2002) Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 87(5):1941–1946

    Article  PubMed  CAS  Google Scholar 

  11. Schneider AB, Ron E, Lubin J, Stovall M, Gierlowski TC (1993) Dose-response relationships for radiation-induced thyroid cancer and thyroid nodules: evidence for the prolonged effects of radiation on the thyroid. J Clin Endocrinol Metab 77(2):362–369

    Article  PubMed  CAS  Google Scholar 

  12. Shibata Y, Yamashita S, Masyakin VB, Panasyuk GD, Nagataki S (2002) 15 years after Chernobyl: new evidence of thyroid cancer. Lancet 358(9297):1965–1966

    Article  Google Scholar 

  13. Hemminki K, Eng C, Chen B (2005) Familial risks for nonmedullary thyroid cancer. J Clin Endocrinol Metab 90(10):5747–5753

    Article  PubMed  CAS  Google Scholar 

  14. Malchoff CD, Malchoff DM (2002) The genetics of hereditary nonmedullary thyroid carcinoma. J Clin Endocrinol Metab 87(6):2455–2459

    Article  PubMed  CAS  Google Scholar 

  15. Uchino S, Noguchi S, Yamashita H et al (2004) Detection of asymptomatic differentiated thyroid carcinoma by neck ultrasonographic screening for familial nonmedullary thyroid carcinoma. World J Surg 28(11):1099–1102

    Article  PubMed  Google Scholar 

  16. Yeh HC, Futterweit W, Gilbert P (1996) Micronodulation: ultrasonographic sign of Hashimoto thyroiditis. J Ultrasound Med 15(12):813–819

    PubMed  CAS  Google Scholar 

  17. Vejbjerg P, Knudsen N, Perrild H et al (2006) The association between hypoechogenicity or irregular echo pattern at thyroid ultrasonography and thyroid function in the general population. Eur J Endocrinol 155(4):547–552

    Article  PubMed  CAS  Google Scholar 

  18. Gutekunst R, Hafermann W, Mansky T, Scriba PC (1989) Ultrasonography related to clinical and laboratory findings in lymphocytic thyroiditis. Acta Endocrinol (Copenh) 121(1):129–135

    CAS  Google Scholar 

  19. Langer JE, Khan A, Nisenbaum HL et al (2001) Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol 176(3):751–754

    PubMed  CAS  Google Scholar 

  20. Pedersen OM, Aardal NP, Larssen TB, Varhaug JE, Myking O, Vik-Mo H (2000) The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 10(3):251–259

    Article  PubMed  CAS  Google Scholar 

  21. Zingrillo M, D’Aloiso L, Ghiggi MR et al (1996) Thyroid hypoechogenicity after methimazole withdrawal in Graves’ disease: a useful index for predicting recurrence? Clin Endocrinol (Oxf) 45(2):201–206

    Article  CAS  Google Scholar 

  22. Baldini M, Orsatti A, Bonfanti MT, Castagnone D, Cantalamessa L (2005) Relationship between the sonographic appearance of the thyroid and the clinical course and autoimmune activity of Graves’ disease. J Clin Ultrasound 33(8):381–385

    Article  PubMed  Google Scholar 

  23. Hiromatsu Y, Ishibashi M, Miyake I et al (1999) Color Doppler ultrasonography in patients with subacute thyroiditis. Thyroid 9(12):1189–1193

    Article  PubMed  CAS  Google Scholar 

  24. Takashima S, Matsuzuka F, Nagareda T, Tomiyama N, Kozuka T (1992) Thyroid nodules associated with Hashimoto thyroiditis: assessment with US. Radiology 185(1):125–130

    PubMed  CAS  Google Scholar 

  25. Cantalamessa L, Baldini M, Orsatti A, Meroni L, Amodei V, Castagnone D (1999) Thyroid nodules in Graves’ disease and the risk of thyroid carcinoma. Arch Intern Med 159(15):1705–1708

    Article  PubMed  CAS  Google Scholar 

  26. Cappelli C, Pirola I, Cumetti D et al (2005) Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? Clin Endocrinol (Oxf) 63(6):689–693

    Article  Google Scholar 

  27. Rago T, Vitti P, Chiovato L et al (1998) Role of conventional ultrasonography and color-flow Doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur J Endocrinol 138(1):41–46

    Article  PubMed  CAS  Google Scholar 

  28. Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T (1995) Thyroid nodules: re-evaluation with ultrasound. J Clin Ultrasound 23(3):179–184

    Article  PubMed  CAS  Google Scholar 

  29. Brkljacic B, Cuk V, Tomic-Brzac H, Bence-Zigman Z, Delic-Brkljacic D, Drinkovic I (1994) Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids. J Clin Ultrasound 22(2):71–76

    Article  PubMed  CAS  Google Scholar 

  30. Cerbone G, Spiezia S, Colao A et al (1999) Power Doppler improves the diagnostic accuracy of color Doppler ultrasonography in cold thyroid nodules: follow-up results. Horm Res 52(1):19–24

    Article  PubMed  CAS  Google Scholar 

  31. Kim EK, Park CS, Chung WY et al (2002) New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 178(3):687–691

    PubMed  Google Scholar 

  32. Nam-Goong IS, Kim HY, Gong G et al (2004) Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf) 60(1):21–28

    Article  Google Scholar 

  33. Frates MC, Benson CB, Doubilet PM et al (2006) Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 91(9):3411–3417

    Article  PubMed  CAS  Google Scholar 

  34. Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA (2003) Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med 22(10):1027–1031

    PubMed  Google Scholar 

  35. Ahuja A, Chick W, King W, Metreweli C (1996) Clinical significance of the comet-tail artifact in thyroid ultrasound. J Clin Ultrasound 24(3):129–133

    Article  PubMed  CAS  Google Scholar 

  36. de los Santos ET, Keyhani-Rofagha S, Cunningham JJ, Mazzaferri EL (1990) Cystic thyroid nodules: the dilemma of malignant lesions. Arch Intern Med 150(7):1422–1427

    Article  PubMed  Google Scholar 

  37. Henrichsen T, Reading CC, Charboneau JW, Donovan DJ, Hay ID (2005) Cystic change in thyroid carcinoma: frequency and extent in 360 cancers by sonography. In: Annual Meeting of Radiology Society of North America, p. 245

    Google Scholar 

  38. Alexander EK, Hurwitz S, Heering JP et al (2003) Natural history of benign solid and cystic thyroid nodules. Ann Intern Med 138(4):315–318

    PubMed  Google Scholar 

  39. Reading CC, Charboneau JW, Hay ID, Sebo TJ (2005) Sonography of thyroid nodules: a “classic pattern” diagnostic approach. Ultrasound Q 21(3):157–165

    Article  PubMed  Google Scholar 

  40. Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 237(3):794–800

    Article  PubMed  Google Scholar 

  41. Taki S, Terahata S, Yamashita R et al (2004) Thyroid calcifications: sonographic patterns and incidence of cancer. Clin Imaging 28(5):368–371

    Article  PubMed  Google Scholar 

  42. Alexander EK, Marqusee E, Orcutt J et al (2004) Thyroid nodule shape and prediction of malignancy. Thyroid 14(11):953–958

    Article  PubMed  Google Scholar 

  43. Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92(8):2917–2922

    Article  PubMed  CAS  Google Scholar 

  44. Jeh SK, Jung SL, Kim BS, Lee YS (2007) Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol 8(3):192–197

    Article  PubMed  Google Scholar 

  45. Brauer VF, Eder P, Miehle K, Wiesner TD, Hasenclever H, Paschke R (2005) Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid 15(10):1169–1175

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Mandel, S.J., Langer, J.E., Duick, D.S. (2008). Ultrasound of Thyroid Nodules. In: Baskin, H.J., Duick, D.S., Levine, R.A. (eds) Thyroid Ultrasound and Ultrasound-Guided FNA. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-77634-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-77634-7_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-77633-0

  • Online ISBN: 978-0-387-77634-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics