ULTRASOUND of the THYROID: what it is for and what it sees

Thyroid ultrasound: definition

L'thyroid and parathyroid ultrasound it is also identified as ultrasound of the neck and lymph nodes. In fact, both exams are studied thyroid gland, the lymph nodes of the neck and to a limited extent i vases of the neck. It is an exam that uses ultrasound issued by a probe to examine the thyroid.

What is the thyroid gland? It is a gland of the organism placed in front of the trachea, in a superficial position below the skin he was born in subcutis. The thyroid gland is made up of two pyramidal structures, the right lobe and the left lobe, connected to each other by aisthmus. In response to the secretion of the TSH or thyrotropin, produced bypituitary gland, the thyroid produces thyroid hormones thyroxine is triiodothyronine (T3 and T4), important for regulating the body's metabolism, the sleep-wake cycle, heart function, growth and cell turnover. For a detailed discussion, please refer to the appropriate article on thyroid.

Preparation and conduct, how a thyroid ultrasound is done

For the Preparation ultrasound of the thyroid gland not it is necessary observe special rules or the fasting.

How is the thyroid echo performed? The sonographer will ask the patient to lie down on his back and extend as much as possible the neck in order to facilitate the examination, raising the chin up. The neck will be examined in its various parts with a high frequency linear probe connected to the ultrasound, applying some gel a base of water to allow the penetration of ultrasound into the soft tissue. It is necessary to remove any jewelry or necklaces that may obstruct the examination, being right where the thyroid is. The patient may be asked to do not talk or swallow to avoid displacements of the structures of the neck that can make the examination difficult.

Ultrasound of the thyroid, parathyroid, neck and lymph nodes

Execution of the thyroid echo: the ultrasound probe, specially wet with a specific water-based gel, is placed on the patient's neck and gently moved to view the various anatomical structures: thyroid, parathyroid, lymph nodes, blood vessels.

What is the thyroid echo for and what does it see?

L'thyroid and neck ultrasound allows you to study:

  • Thyroid gland, and the following features:
    • It is useful for defining size thyroid gland, which can be increased or decreased in some diseases. Both hypothyroidism and hyperthyroidism can cause the gland to enlarge or reduce in size. For this reason, the differential diagnosis also depends on the clinic and the values of thyroid tests. Patients who have been taking eutirox for a long time due to hypothyroidism usually have a small thyroid.
    • In patients with very large thyroid glands, it is referred to as goiter. The study of the thyroid with ultrasound may be useful for examining the relationships gland with nearby structures, such as the trachea and esophagus, to prepare for some surgery or clarify the origin of some symptoms that can be caused by goiter, such as difficulty swallowing or breathing.
    • There may be an asymmetry the size of the thyroid gland, with one lobe being larger than the other, for example due to a thyroid nodule.
    • It also investigates the ultrasound structure of the thyroid, i.e. its appearance on ultrasound. There may be fibrosis, for example in some cases of advanced thyroiditis, or an inhomogeneous ecostructure.
    • Presence of injuries. There can be gods nodules or cyst, which make the thyroid inhomogeneous. The study of thyroid nodules and cysts is done by following some appropriate classifications, which allow us to understand if the thyroid nodules are benign or malignant. Benign nodules do not pose a risk, it is not necessary to remove them. Nodules malignant, on the other hand, can develop into a tumor, and make thyroidectomy operations necessary. Cysts are always considered benign, they represent collections of colloid fluid (formed by the hormones produced by the gland) within the thyroid parenchyma. Nodules not cystbic, on the other hand, can be malignant if solid, or in the presence of calcification, if with irregular and not well defined margins and if very vascularized. The diagnosis of certainty on the malignancy of a nodule is however only with needle biopsy or thyroid fine needle aspiration.
    • Doppler ultrasound is also used to assess thyroid vascularity, which may be increased in some forms of thyroiditis, or may be altered by the presence of nodules.
  • Lymph nodes in the neck. They can be enlarged in case of infectious or inflammatory events, for example for a trivial flu or mononucleosis. If inflammatory, benign, they are oval, painful, and usually return to normal size after a few weeks.  Lymph nodes malignancies can be the result of a tumor in nearby tissues, or lymphomas, and are instead spheroidal.
  • Major salivary glands sometimes they are studied in the context of the thyroid echo, they are the two submandibulars located under the jaw and the parotid in front of the ear. Stones with sialolithiasis, infections, abscesses, autoimmune diseases with glandular inflammation or tumors can be recognized.
  • Parathyroid glands, four small glands that are actually difficult to visualize if there is no hyperplasia, and are located posterior to the thyroid.
  • Vessels of the neck: the vessels of the neck are also displayed, in particular the carotids, where plaques can be seen. However, for the study of the plaques it is necessary to perform a different examination, theechocolordoppler of the supraaortic trunks (or TSA). It may therefore happen to a patient who performs a thyroid echo, that for the detection of some plaques in the carotids it is recommended to perform another examination for the vessels of the neck.
  • Other neck structures are displayed but it is not possible to study them in detail with the ultrasound alone, we just observe their correct position. They are for example the trachea and theesophagus.

Directions for execution

The indications neck ultrasound are many.

  • symptoms clinical of hypothyroidism. For example tiredness, sleepiness, loss of appetite, weight gain, dyspnoea, difficulty concentrating and others. Your doctor, if deemed necessary, may recommend some thyroid tests and ultrasound if blood tests are abnormal.
  • symptoms clinical of hyperthyroidism. For example, insomnia, sweating, eye disorders, tremors, nervousness, tachycardia, weight loss and a disproportionate increase in appetite. Also in this case the doctor, if he deems it necessary, can recommend some thyroid tests and ultrasound.
  • in case of goiter, with increase visible of size of the thyroid gland. Goiter can originate from several causes, one of which is the lack of iodine, a necessary element to produce thyroid hormones. In the event of a deficiency, the thyroid begins to enlarge in an attempt to take in more iodine from the blood, resulting in goiter. Large goiters, so much so as to be evident when observing the neck, were found above all in the past and in some regions, especially mountainous, where iodine is often lacking. Today this hardly happens, because even in these geographical areas iodine is supplemented with the use of iodized salt, and also for advances in the medical field that allow for early diagnosis.
  • control is surveillance clinic of thyroid nodules already known, or if you suspect a thyroid nodule. Nodules are formations that are often found by chance. Later, the patient may need annual thyroid ultrasound scans.
  • in case of suspected of thyroiditis, in patients with manifestations of diseases such as vitiligo or celiac disease that often accompany glandular pathologies, or in patients with familiarity with thyroiditis.
  • control of a thyroiditis. Patients with thyroiditis are at increased risk of developing thyroid cancer, and should therefore undergo periodic checks.
  • for control in patients with genetic syndromes such as Down, Turner and Klinefelter syndromes, in which thyroiditis, as well as other autoimmune diseases, are more common.
  • appearance of palpable swellings in the neck. For example, for inflammation and enlargement of some lymph nodes, which may deserve an ultrasound study to determine if they are inflammatory or malignant.
  • I suspect sialolithiasis, that is, formation of a stone in a salivary gland. It usually manifests as meal-related pain, lumpiness and swelling in the jaw or in front of the ear.
  • in preparation for pregnancy, especially in patients with thyroiditis. This is because thyroid hormones are very important for the normal growth of the embryo during gestation, and it is therefore important in these patients to check the values of the thyroid tests and the appearance of the gland before conception.

Complex pictures of thyroid diseases, especially if accompanied by familiarity or autoimmune manifestations, may deserve advice from endocrinologist specialist.

Other exams

Sometimes, especially if large nodules or goiters are found, other tests may be necessary in addition to ultrasound. This is usually indicated in the ultrasound report, or may be requested by the endocrinology specialist. The method can be integrated with one scintigraphy with technetium, in the case of nodules, to see if the latter are hot nodules (pick up the radioactive tracer) or cold nodules.

Hot nodules are usually gods benign adenomas, cold nodules on the other hand can be more frequently malicious. In goiter, in the presence of a tumor or very large and suspicious nodules, it may be good to perform one TC neck or one magnetic resonance, both to study the structure of the thyroid gland and its relationships with nearby tissues, both to see if they are damaged by the disease, and in preparation for any surgery.

Cost of thyroid ultrasound

Perform an echocolordoppler of the thyroid gland, how much? In the public, via ticket, the price of the performance is around 30 EUR. In the private sector, the cost ofthyroid ultrasound it is very variable depending on the center in which it is performed, it can in general exceed i 70 euros.

Sources:

Thyroid Imaging Reporting and Data System (TI-RADS), American College of Radiology, 2017

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