Case 8

Female
70
-

Exam Date: 15/11/2023

US: Thyroid gland

Clinical information: Follow up thyroid nodules
Comparison: 21/03/2023.

FINDINGS:

Increase in size of Nodule #1
Location: upper pole of right lobe
Composition: mix solid-cystic lesion
Size: 1.28 x 0.82 x 2.07 cm
Echogenicity: isoechoic
Shape: wider-than-tall
Margin: well-defined
Echogenic foci: punctate echogenic foci
TIRAD 4: moderately suspicious

No significant change of Nodule #2
Location: lower pole of right lobe
Composition: solid lesion
Size: 1.0 x 0.8x 1.5 cm
Echogenicity: hypoechoic
Shape: wider-than-tall
Margin: well-defined
Echogenic foci: none
TIRAD 4: moderately suspicious

No significant change of Nodule #3
Location: lower pole of left lobe
Composition: solid lesion
Size: 0.6 x 0.7 x 1.1 cm
Echogenicity: hypoechoic
Shape: wider-than-tall
Margin: Ill-defined
Echogenic foci: Rim calcification
TIRADS 4: moderately suspicious

– Few cysts at bilateral lobes of thyroid.
– Lymph node: No significant cervical lymphadenopathy.
– Normal appearance of bilateral submandibular glands.

IMPRESSION:

– Increase in size of TIRADS 4 mix solid-cystic nodule at upper pole of right lobe, 1.28×0.82×2.07
cm.
– No significant change of nodules at lower pole of right and left lobes, as described.
– Few cysts at bilateral lobes of thyroid.

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
– TI-RADS 4: Moderately suspicious – FNA if >= 1.5 cm , Follow if >= 1 cm
– TI-RADS 5: Highly suspicious – FNA if >= 1 cm, Follow if >= 0.5 cm