Case 10

Male
69
-

Exam Date: 14/09/2023

US: Thyroid gland

ULTRASOUND OF THE THYROID

HISTORY: Thyroid nodules; follow-up.
COMPARISON: 27-Mar-2023.

FINDINGS:

Thyroid:
Right lobe: Size = 1.5×1.8×4.4 cm. Heterogeneous echogenicity.
– Increased number of multiple solid hypoechoic nodules scattering in right lobe with no change of
the largest 0.4×0.5×0.6-cm nodule at mid pole. (TIRADS 4)
– A few cysts at upper and lower poles, measured 0.2-0.3 cm.
Left lobe: Size = 1.5×1.5×3.9 cm. Normal echogenicity.
– A few nodules now seen as mixed solid-cystic nodule with macrocalcification (TIRADS 4) and increased vascularity at upper-mid pole;

  • 0.6×0.8×1.2-cm at upper pole.
  • 0.5×1.0×1.4-cm at upper pole, and
  • 0.4×0.6×0.8-cm at mid pole.

– Two 0.4-cm cysts at upper and lower poles.

Isthmus: Thickness = 2 mm. No mass
Cervical lymph nodes: A0.4-cm lymph node withthickened cortex at left upper cervical region. No change of several subcentimeter bilateral cervical lymph nodes with preserved fatty hila.
Others: No change of mild heterogeneous echogenicity of bilateral submandibular glands.

IMPRESSION:

– Parenchymatous disease right thyroid lobe.
– Multiple thyroid nodules;

  • Increased number of multiple TR4 nodules scattered in the right lobe with no change in size of the largest (0.6 cm) nodule, moderately suspicious.
  • Nodules in the left lobe now seen as TR4 nodules with macrocalcification and increased vascularity at the upper pole (1.2-cm and 1.4-cm) and mid pole (0.8-cm), moderately suspicious. Fine Needle Aspiration (FNA) of the largest nodule is advised.
  • A few cysts in both lobes of the thyroid gland.

– 0.4-cm lymph node with thickened cortex at left upper cervical region.
– Mild parenchymatous disease of bilateral submandibular glands is suggested.