thyroid nodule

Differentiation

of benign and malignant thyroid nodules based on the proportion of sponge-like areas on ultrasonography | Grading of sponge-like nodules. The grades were determined according to the proportion of areas with a sponge-like appearance within each nodule. Grade I was defined as 75%.

www.e-ultrasonography.org • CC by nc

Makrofollikulärer

Strumaknoten, gemischt zystisch - solide.

Wikipedia • CC BY-SA 4.0

Papilläres

Schilddrüsenkarzinom mit kleinen echoreichen Foci.

Wikipedia • CC BY-SA 4.0

Papilläres

Schilddrüsenkarzinom mit Organüberschreitung: Die Infiltration bis in das angrenzende parathyreoidale Weichgewebe nach ventral ist in der Sonographie schon zu erkennen (TI-RADS-Kriterium). Oberes Bild längs, unteres quer dargestellt.

Wikipedia • CC BY-SA 4.0

Comet tail

artifact • Thyroid colloid nodule - Ganzer Fall bei Radiopaedia

Bickle, I. Thyroid colloid nodule. Case study, Radiopaedia.org. (accessed on 02 Nov 2022) https://doi.org/10.53347/rID-55510 • CC by-nc-sa 3.0 (modified)

Ultrasonography

of thyroid nodules: a pictorial review. (a) A benign nodule. It is iso-echoic relative to the thyroid, and surrounded by a hypo-echogenic halo. (b) A benign cystic nodule with multiple colloids, which are seen as hyper-echoic spots with comet-tail. (c) A benign nodule with hypo-echoic cystic spaces resulting in a spongiform or honeycomb appearance. (d) A benign nodule with eggshell calcification. Note the acoustic shadowing produced by the calcific ring. (e) A benign nodule with eggshell calcification. (f) A benign nodule with peripheral vascularity on Doppler assessment

insightsimaging.springeropen.com • Open Access

Szintigrafie

eines autonomen Schilddrüsenadenoms

Wikipedia • Public domain

Schilddrüsenszintigramm

10 min. p.i. nach 70 MBq 99mTc-Pertechnetat. Großer kalter Knoten caudal im rechten Schilddrüsenlappen, kleinerer kalter Knoten lateral im linken Schilddrüsenlappen.

Wikipedia • CC BY-SA 4.0

Human thyroid

with cancer nodules

Wikipedia • Public domain

Hyperplastischer

Strumaknoten, mäßig hypoechogen. Keine Malignität.

Wikipedia • CC BY-SA 4.0

Thyroid

nodule • Papillary thyroid carcinoma - Ganzer Fall bei Radiopaedia

Di Muzio B, Papillary thyroid carcinoma. Case study, Radiopaedia.org (Accessed on 15 Apr 2023) https://doi.org/10.53347/rID-55436 • CC by-nc-sa 3.0 (modified)

Thyroid

nodule • Benign thyroid nodule - Ganzer Fall bei Radiopaedia

Gaillard F, Benign thyroid nodule. Case study, Radiopaedia.org (Accessed on 15 Apr 2023) https://doi.org/10.53347/rID-9414 • CC by-nc-sa 3.0 (modified)

Thyroid

nodule • Microlobulated margin of thyroid nodule: metastasis to thyroid - Ganzer Fall bei Radiopaedia

Matifoll A, Microlobulated margin of thyroid nodule: metastasis to thyroid. Case study, Radiopaedia.org (Accessed on 15 Apr 2023) https://doi.org/10.53347/rID-33088 • CC by-nc-sa 3.0 (modified)

Medullary

thyroid carcinoma • Medullary thyroid carcinoma with nodal metastases - Ganzer Fall bei Radiopaedia

Ashraf A, Medullary thyroid carcinoma with nodal metastases. Case study, Radiopaedia.org (Accessed on 25 Jan 2023) https://doi.org/10.53347/rID-83342 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

Thyroid nodules are any discrete lesion that can be delineated on imaging studies from the adjacent thyroid parenchyma. They can represent a range of benign or malignant conditions.

Epidemiology

They are more common in females (4:1 F: M) and have an increasing prevalence with increasing age and reduced iodine intake . The incidence is estimated at 0.1% with a lifetime prevalence of 10% .

Clinical presentation

Thyroid nodules are a common incidental finding on imaging (see: incidental thyroid nodules), present in ~10% of CT and MRI neck examinations, ~50% (range 20-76%) of ultrasound neck ultrasound, and 55% (range 50-65%) of autopsies . They can also be found on clinical examination as palpable lesions in the neck, although this clinical finding does not represent a thyroid nodule if there is no imaging correlate.

When symptomatic, patients may present with thyroid dysfunction or rarely compressive symptoms .

Pathology

Thyroid nodules are typically benign. The prevalence of malignancy (based on biopsy) in thyroid nodules is ~10% (range 4-6-15%) .

Etiology

There are many causes of thyroid nodules, some of the more common causes are listed below:

benign nodules
- follicular adenoma
  - colloid nodule
- Hurthle cell adenoma
- thyroid cyst: simple, hemorrhagic
- focal/asymmetrical thyroiditis
  - lymphocytic (Hashimoto) thyroiditis
  - granulomatous (de Quervain) thyroiditis
malignant nodules
- primary thyroid cancer
  - papillary thyroid carcinoma
  - follicular thyroid carcinoma
  - Hurthle cell carcinoma
  - poorly differentiated carcinoma
  - medullary thyroid carcinoma
  - anaplastic thyroid carcinoma
- thyroid lymphoma: primary or secondary
- metastases to the thyroid

Radiographic features

Ultrasound is the modality of choice for diagnostic assessment of thyroid nodules . It also allows for ultrasound-guided fine-needle aspiration of selected nodules.

Treatment and prognosis

As thyroid nodules are commonly incidental, there are numerous classification systems to help with risk stratification. See article: Incidental thyroid nodules for further detail.