Case 5

Female
64
-

Exam Date: 12/10/2023

US: Thyroid gland

Clinical information: Right thyroid nodule

Findings:

Background thyroid: normal size and echogenicity without significant increased vascularity
Nodules:
– A mixed cystic and solid isoechoic mass at mid pole of right lobe with punctate echogenic foci, size 2.19×1.65×2.74 cm: ACR TI-RADS 4
– A solid hypoechoic lesion at mid pole of right lobe, size 0.40×0.44×0.53 cm: ACR TI-RADS 4
– A solid hypoechoic lesion at upper pole of left lobe, size 0.49×0.26×0.44 cm: ACR TI-RADS 4
– Few cysts and spongiform nodules in both lobes
Lymph node: No significant cervical lymphadenopathy

Recommendation:

– FNA at the large right lobe mass with punctate echogenic foci

ACR TI-RADS 2017 management recommendations
– TI-RADS 1: Benign – No FNA
– TI-RADS 2: Not suspicious – NO FNA
– TI-RADS 3: Mildly suspicious – FNA if >= 2.5 cm, Follow if >= 1.5 cm at 1, 3and 5yr
– TI-RADS 4: Moderately suspicious – FNA if >= 1.5 cm, Follow if >= 1 cm at 1, 2, 3 and 5 yr
– TI-RADS 5: Highly suspicious – FNA if >= 1cm, Follow if >=0.5 cm annually until 5yr