CLINICAL
APPLICATIONS
THYROID ULTRASOUND¹
Characterization of Thyroid Nodules (both palpable and non-palpable)
Measure and Characterize Nodules (cystic vs. solid, size, echogenicity, calcifications...)
Objective monitoring over time, particularily when performed by the same provider
Charcterize thyroid disesase (such as Hashimotos, Graves)
Guide biopsy or fine needle aspiration
Assess extrathyroidal neck
Follow up of post-surgical thyroid cancer patients
Confirmation of Normal Thyroid Anatomy²
Each lobe has oval shape with rounded superior pole and elongated inferior pole
Lobe dimensions may vary greatly from 4 to 6 cm in length
Usually the lobe thickness (AP dimension) is less than 2 cm
Normal adult thyroid volume is 15 ± 4.6 cc

THYROID NODULE BIOPSIES³
In the past, physicians would routinely aspirate any nodules larger than 1 cm in diameter and leave any that were smaller than 9 mm. Dr. Mandel now suggests the following two approaches:
Aspirate any solid nodules that are larger than 15 mm and recommend surgery if the biopsies show suspiscious cytology.
If a nodule is of borderline size, for instance, between 8 and 15 mm, use ultrasound features to determien whether to perform or refrain from biopsy, and follow the patient medically. Suspicious ultrasound features (determined and validated by several researchers) include
Hypoechogenicity in the nodule compared with surrounding thyroid parenchyma;
Microcalcifications present;
Nodule’s margin irregular and poorly defined;
Increased intranodular bloodflow;
Absence of transonic rim or halo surrounding the nodule.

PARATHYROID ULTRASOUND¹
Preoperative localization
Appreciation of anatomy in 3 dimensions
Localize ectopic parathyroid
Guide biopsy or fine needle aspiration

HEAD AND NECK ULTRASOUND¹
Salivary gland
Larynx and Vocal Chords
Pharynx
Esophageal
Face
Paranasal Sinuses
Ear
Other neck masses (including benign LNs and lymphoma)
1Orloff, Lisa A. Ultrasonography in the Thyroid Surgery Practice. Head and Neck Endocrine Surgery, 27 Oct. 2006, Head and Neck Endocrine Society. San Francisco, California: UCSF School of Medicine, 2006.

2Mandel, Susan, MD, MPH. Thyroid Ultrasound: Diagnostic Use. Thyroid Sonography Workshop, 6 Oct. 2005, The Endocrine Society. Toronto, Canada: The Endocrine Society, 2005.

3Kristiansen, Cathy. "When to Be Selective with Thyroid Nodule Biopsies." Endocrine News 30.4 (2005): 16.
 
 
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