IMAGING OF THE THYROID

1
IMAGING OF THE THYROID

• Dr Jill Hunt
• Consultant Radiologist
• West Herts NHS Trust

2
Imaging techniques

• ULTRASOUND
• Nuclear medicine
• CT
• MRI
• PET/CT

3
WHO TO SCAN?

• Clinical goitre
• Palpable nodule
• Cervical lymphadenopathy
• Thyroid lesions on CT/MRI
• Thyroid lesions on PET
• Not for hyper/hypothyroid patients without
  palpable abnormality as general rule

4
NODULAR THYROID DISEASE

• Multinodular goitre
• Adenomas
• Colloid nodules
• Cysts
• Tumours Papillary, Follicular, Anaplastic,
  Medullary cell, Lymphoma, Metastases
• Thyroiditis

5
DIFFUSE THYROID DISEASE

• Graves Disease
• Hashimotos thyroiditis (may be nodular)
• Subacute lymphocytic thyroiditis
• Subacute viral thyroiditis
• Reidels thyroiditis
• AIT

6
NODULE ASSESSMENT

• (Palpable or impalpable)
• Solitary or multiple
• Size and shape
• Echogenicity /- cystic change
• Definition/halo
• Calcifications
• Vascularity

7
THE PROBLEM WHICH FOR FNA

• Prevalence 5 by palpation
• Prevalence of clinically inapparent nodules at US
  20-75
• 20-48 patients with 1 palpable nodule have
  additional nodules on US
• 5 of thyroid nodules will be malignant
• No. of thyroid cancer cases in UK in 2007 - 2108

8
(No Transcript)
9
Benign lesion with spongiform appearance
10
Colloid nodule
11
Papillary carcinoma
12
Anaplastic carcinoma
13
CLINICALLY SUSPICIOUS FEATURES

• Hx of head/neck DXT
• FHx of MTC, papillary ca or MEN Type 2
• Age lt14 or gt70
• Male
• Growing nodule
• Firm/hard/fixed nodule
• Cervical lymphadenopathy
• Persistent dysphonia/dysphagia/dyspnoea

14
NUCLEAR MEDICINE
15
CT OF THE THYROID
16
MRI of a papillary carcinoma
17
CT/PET of the thyroid
18
CONCLUSION

• Ultrasound /- FNA remains the mainstay of
  thyroid imaging
• Nuclear medicine still has limited role
• CT, MRI and CT/PET small number of specific
  indications