Dr Anil D Rao Consultant Department of Surgery KTPH. Diffuse...Dr Anil D Rao Consultant Department...
Transcript of Dr Anil D Rao Consultant Department of Surgery KTPH. Diffuse...Dr Anil D Rao Consultant Department...
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DIFFUSE THYROID CONDITIONS
Dr Anil D RaoConsultant
Department of SurgeryKTPH
DIFFUSE THYROID ENLARGEMENT – NORMAL FUNCTION AND ECHOGENECITY
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DIAGNOSTIC ULTRASOUND FOR THYROID NODULES
• CONFIRM SONOGRAPHICALLY IDENTIFIABLE NODULE CORRESPONDING TO PALPABLE NODULE (16% NON CORRESPONDENCE)
• DETECTION OF ADDITIONAL NODULES
1. SOLITARY NODULE
2. DOMINANT NODULE
• IDENTIFICATION OF SONOGRAPHIC FEATURES FOR FNA SELECTION
• SIZE
ECHOGENECITY
• NORMAL THYROID IS HOMOGENOUSLY HYPERECHOIC COMPARED TO STRAP MUSCLES
• NODULE ECHOGENECITY IS DEFINED RELATIVE TO NORMAL THYROID
1. ISOECHOIC / HYPERECHOIC – grouped together
2. HYPOECHOIC
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ISO / HYPERECHOIC NODULES
BENIGN HYPERPLASTIC NODULEFOLLICULAR CANCER
Thyroid Imaging Reporting And Data Systems ( TIRADS)CLASSIFICATION
• TIRADS 1 – Normal thyroid gland
• TIRADS 2 – Benign lesions : 0% RISK
• TIRADS 3 – Probably benign lesions : < 5% RISK
• TIRADS 4 – Suspicious lesions
1. 4a (score 1) – UNDETERMINED : 5-10% RISK
2. 4b (score 2) – SUSPICIOUS : 10-50% RISK
3. 4c (score 3-4) – HIGHLY SUSPICIOUS : 50-85% RISK
• TIRADS 5 (score 5)- Probably malignant lesions ( > 85% RISK)
• TIRADS 6 – Biopsy proven
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SONOGRAPHIC FEATURES
1. Solid component.
2. Markedly hypoechoic nodule
3. Microlobulations or irregular margins
4. Microcalcifications
5. Taller-than-wider shape
TIRADS 2
CYST
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TIRADS 2
SOLID NODULEWITH CENTRAL CYST
TIRADS 2
NODULEWITHHOMOGENOUS PERIPHERAL CALCIFICATION
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TIRADS 2
AVASCULAR ANECHOIC NODULE WITH ECHOGENIC SPECKS
TIRADS 2
VASCULAR AND HETEROECHOIC WITH HALO
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TIRADS 3
HYPERECHOICISOECHOIC
TIRADS 4 AND 5
MARKEDLY SOLID COMPONENT
MARKEDLY HYPOECHOIC
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CLINICAL SCENARIO - 1
A 36 year old female patient is noted to have a incidental finding of a 2 cm size right sided thyroid nodule at pre-employment check.
She has no family history of thyroid ailments and is clinically & biochemically euthyroid.Bedside ultrasound scan is shown below
SPONGIFORM NODULE< 2% RISK OF CANCER
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CLINICAL SCENARIO - 2
A 44 year old male patient presented to your clinic with a slow growing left sided thyroid nodule. You order an ultrasound scan for him which shows a large 3 cm size nodule. He is worried about cancer
PURELY CYSTIC LESIONS. IDEALLY TREATED BY ASPIRATION /EXCISION (excision> 4 cm diameter / recurrent)
NOT SUITABLE FOR FNAC
CLINICAL SCENARIO - 3
A 26 year old female patient presented to your clinic with a incidental finding of a right sided thyroid nodule. She is asymptomatic and has no family history of thyroid ailments. Her bedside ultrasound scan is as below
9 MM COMPLEX CYST
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CLINICAL SCENARIO - 4
A 44 year old female patient presented to your clinic with a recently diagnosed leftthyroid nodule.She is asymptomatic and has a positive family history of thyroid ailments.Her bedside ultrasound scan shows multiple small nodules with one dominant noduleshown below
HYPOECHOIC NODULE
CLINICAL SCENARIO - 5
A 65 year old lady presents to your gp clinic with mild recent onset discomfort in herneck.She has a longstanding goiter and has been told in the past that she has HashimotosThyroiditis. Her family members have noted a recent increase in size of the goiter
EXTREMELY HYPOECHOIC NODULE
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CLINICAL SCENARIO - 6
A asymptomatic 44 year old housewife is following up for a small right thyroid nodule.She has declined treatment in the past and is now worried.The latest scan of the nodule shows some calcification as shown below.
COMPLETE CURVILINEAR CALCIFICATION –USUALLY BENIGN
CLINICAL SCENARIO - 7
A 38 year old man presents to your GP clinic with a slow growing right thyroid nodule.Ultrasound scan is shown below. The finding of concern here is
IRREGULAR MARGIN