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Thyroid ultrasound - training that shows what is the norm?

To date, there is no more simple and safe, yet highly informative method of diagnosis than ultrasound. This method allows to determine the structure, the structure and location of the thyroid gland. In the course of a primary disease diagnosis of this procedure on ultrasound plays a key role.

More serious and costly diagnostic methods (CT, MRI) can be used only in case of the need for more thorough research, as well as in cases difficult for ultrasonic waves to the location of the gland (retrosternal).

For diagnosis by means of ultrasonic method used in modern devices with additional features (Doppler). High-precision sensors allow to detail and the ability to assess the condition of the thyroid gland and its surrounding anatomical structures (muscles, vessels). The method of dopplerography allows to accurately determine the level of blood flow in the prostate and nearby lymph nodes. On the background of drug therapy Doppler method will allow you to track the effectiveness of treatment on the dynamics of the pathological process.


The content of the article:


Preparation for ultrasound of the thyroid gland

Much prior this study does not require because of the convenient location of the thyroid gland.

However, if you wish to receive further information (assessment of the level of blood flow) should follow some rules:

  • The day before the procedure you should refrain from taking medications that affect the level of blood pressure and volume cardiac output;

  • To completely eliminate the use of alcohol for 3 days before the procedure;
  • The elderly should pay attention to the fact that research is best done on an empty stomach, given the possible emergence of a gag reflex when pressing the ultrasonic transducer on the region of the gland.

During the procedure the patient takes a horizontal position on the back, andto improve the conductivity of the ultrasonic waves to the place of study to apply a specialized gel. The duration of the diagnostic process is not more than 15 minutes, depending on the goals and objectives of the study. Decoding the received results can be obtained immediately after the ultrasound of the thyroid gland.

It is advisable to carry a paper towel to remove remaining gel.


Evaluation of the results of the study

To understand the overall clinical picture, as well as performances of the probable diagnosis, a doctor performing ultrasound of the thyroid gland, needs to define the following parameters:

  • The location of the gland. If the gland is located within the anatomical norms, this situation is called typical. With the development of the pathological process location of cancer is aberrant. The most common aberrant location is the root of the tongue. Perhaps the appearance ectobiology sections of the thyroid gland, which border the main fabric body;
  • The structure of the gland. Anatomical principle assumes the presence of a pair of lobes and a small isthmus. There are cases of the formation of another (pyramidal) lobe and tissue growths, which are located in the lower poles of the lobes and down to the thymus (his horns). As a result of violations of fetal the formation of the thyroid gland, its location can be unilateral (instead of the normal split). This condition is called "agenesis of the thyroid lobe". In the case of complete underdevelopment of the body, the pathology is called "aplasia of the thyroid gland";
  • The contours of the gland. This parameter is quite informative in terms of diagnostics of inflammatory and neoplastic process. By its nature, the contours of the thyroid gland can be clear and unclear. It is the presence of fuzzy contours gives grounds to confirm the presence of the pathological process;
  • The size of the gland. This parameter is valuable in matters of diagnosis of hyperplasia and hypoplasia of the tissues of the body. With the aim of determining the size of the isthmus is the measurement of its thickness in the direction from front to back. To obtain data on the volume of the prostate is measurement of the three linear parameters in perpendicular planes;

  • The structure of the gland. In the absence of any pathology the structure of the gland is homogeneous with the presence of specific grain sizes. Subject to the inflammatory process, the structure of the gland may lose uniformity;
  • Echogenicity of the thyroid gland. The term"echogenicity" refers to the contrast of the colors of the gland, when it is displayed on the screen of the ultrasound apparatus;
  • Focal education. Mandatory description of detected focal lesions. By these are meant all sorts of knots, cysts, and calcification;
  • The structure of the regional cervical lymph nodes. A prerequisite is the determination of their size, General structure, presence of pathological formations. For a malignant process characterized by loss of the internal structure of the lymph nodes, the absence of a clear picture of the "gate"of the lymph node (the introduction of lymphatic vessels in the node). The most significant indicators include the presence of calcification, an increase in blood flow in the lymph nodes, as well as the appearance of cystic transformation. All these signs indicate the development of cancer.

The results of the thyroid ultrasound is made the appropriate conclusion. It should provide correct information relative to the ultrasound features. For example, the formulation of outcomes should be not"Adenoma of the left lobe of the thyroid gland"and"signs of the presence of nodes of the left lobe of the thyroid gland".

Do not confuse the results of a thyroid ultrasound with the final and accurate diagnosis. Attempts to the physician conducting the diagnosis, to make our own diagnosis based on the results of ultrasound go far beyond his competence, and are erroneous.


The normal thyroid ultrasound

After conducting thyroid ultrasound natural desire of the patient is to receive a transcript of results. Below will be outlined the main language used by the doctors, and their detailed explanation.

The most valuable information plan for the specialist conducting the thyroid ultrasound, are the following:

  • The homogeneity of the structure of the gland;
  • The intensity of the vascularity of the gland;
  • The clarity of the contours of the gland;
  • The change in echogenicity of the gland;
  • The presence of structural and organic changes in the gland tissue (cysts, nodes, calcification).

Along with the thyroid gland, monitoring and assessment of nearby regional lymph nodes.

So, we go directly to the assessment and interpretation of the main study parameters:

  • The contours of the thyroid can have differentdegree of definition. Indicator standards are considered to be completely clear outlines. A deviation from the norm, as well as an indicator of the presence of inflammatory and neoplastic process are not clear, the contours of the thyroid gland. It was out of the malignant process beyond the gland gives fuzzy picture of the contours;
  • The structure of the fabric is another important indicator, it can be both homogeneous and heterogeneous. The thyroid gland is normal may only have a homogeneous structure with the presence of the characteristic speckle noise. The heterogeneity of the structure indicates the development of the pathological process. Inflammatory diseases of the thyroid autoimmune nature may occur on the background of structural heterogeneity. Then the tissue of the thyroid gland can resemble a honeycomb. In medical practice there are two types of the description of the heterogeneous structure of thyroid tissue: "markedly heterogeneous"and"moderately non-uniform". In the first case we can speak about pathological changes, but the second option can be considered a normal variant. Moderate heterogeneity is not uncommon in perfectly healthy people, and it is caused by the increased levels of antibodies to tireoglobulina;

  • The echogenicity of thyroid tissue is determined by the picture that shows the monitor screen of the ultrasound apparatus. Be aware that the display image is formed by computer processing of received ultrasonic signals. The term "echogenicity" refers to a light gray color, which represents the thyroid gland on the monitor screen. Indicator standard is absolute compliance with the echogenicity of the parotid salivary gland and the thyroid gland. The development of the inflammatory process echogenicity of the thyroid gland tends to decrease, when severe currents may be increased. About decrease in echogenicity demonstrated by the increased thyroid tone compared to the tone of adjacent muscles. The change of this index is a serious signal for the doctor of ultrasonic diagnostics. The normal levels of echogenicity can vary slightly, but normally, iron has a lighter tone compared to the surrounding blood vessels and muscles;
  • Focal changes (nodes) cannot be included in a healthy thyroid gland. Permissible deviations from the norm are considered to be a small cyst-like formation, the diameter of which does not exceed 4 mm. On the screen of the ultrasound apparatus these structures have a homogeneous structure and color are completely black (no echogenicity). This is a common follicles,filled with colloid (a gelatinous hormonogenesis component). When detecting objects of large diameter and substantially differing in their echogenicity of thyroid tissue is possible with confidence to speak about the presence of nodes.

Nodes to classify, in the following order:

  • Isoechoic do not differ in their level of echogenicity of thyroid tissue;
  • Hypoechoic characterized by a decrease in the level of echogenicity compared with the surrounding tissues of the gland (dark);
  • Hyperechogenic, characterized by an increase in the level of echogenicity compared with the surrounding thyroid tissue (light);
  • Anechoic, which are characterized by all black color, and it may indicate the presence of the cavity, which is filled with fluid (cyst).

The appearance of the nodes in the thyroid gland, in any case can not be considered a normal variant. The normal state of the body indicates the uniformity of structure and the absence of any nodes.

In case of detection of the node of the doctor of ultrasonic diagnostics should be its characteristic, which includes the following options:

  • The clarity of the contours;
  • The presence or absence of the rim "halo", which is located on the periphery of the node;
  • The degree of echogenicity of the node.
  • The presence or absence of foci of calcification (on the basis of acoustic shadow);
  • Linear dimensions (there are three basic options that allow you to measure the volume of the node);
  • The presence or absence of cystic transformation.

Blood flow to the tissues of the thyroid gland, or rather, its intensity, is determined by the research method Doppler. Indicator of norms is the presence of individual signals on the surface of the thyroid gland. In the formation of the inflammatory process, blood flow in the gland increases several times, so on on the screen looks like a burning object.

Regional lymph nodes of the neck in the normal state are not increased. Normally, they have a clear and smooth contours, the length dominates over width, the structure can be traced pronounced "gate". The bloodstream in the lymph nodes should not be strengthened. The presence of cysts is not normal and may indicate the development of malignant pathology.

Ultrasound signs of thyroid gland diseases

In the process of analysis of the received results of ultrasound thyroid gland, the doctor should describe a list of parameters which have important clinical and diagnostic value. Characteristics of common indicators allows you to diagnose a number of diseases of the thyroid gland. For example, increasing the size of the organ in combination with a decrease in its echogenicity and lack of uniformity of the structure may be indicative of autoimmune thyroiditis in hypertrophic type, or diffuse toxic goiter. For confirmation of these diagnoses is necessary to study gormonoobraznye function of the gland.

But there are a number of quite specific indicators, the detection of which on thyroid ultrasound it is possible to speak with confidence about the development of a particular pathology. Consider the most characteristic of them.

The lack of thyroid in the typical place and below its subject is not previously conducted operations on the neck may indicate intrauterine hypoplasia of the gland (agenesis) or an atypical location (lingual goiter). People suffering from agenesis, aware of their diagnosis since its formulation, so they need before conducting thyroid ultrasound can inform the doctor. In the case of atypical locations on people are often not aware of this, since the function of a gland is not broken, and the man did not bother.

When the location of the glands at the root level of the language there is a partial overlap of the lumen of the pharynx that entails a violation of the act of swallowing and creates a feeling of "lump in the throat". This defect is the most common complaint of people with thyroid pathologies.

In the case of an atypical location of the thyroid gland, and in the absence of information about insufficient production of hormones, it is mandatory to conduct additional research methods, such as computed tomography of the neck and the chest, to determine the true location of the thyroid gland.

The presence of cystic masses in the midline of the neck above the isthmus of the thyroid gland, located close to the hyoid bone, says the median cyst neck. It is a pathological formation begins with the formation in utero. Diagnosis is not extremely difficult. Patients with median cyst complain of periodic emergence of a kind of mound in the neck. There are cases of development of purulent process in the cavity of the cyst. Characteristic signs of development of purulent process isredness of the skin on the neck, presence of typical pain during a touch, the local temperature rise.

This problem is solved exclusively by surgical intervention to remove the cyst. Before formulating the final diagnosis, the doctor should bear in mind that this cystic formation may be the result of metastasis of thyroid cancer. Surgical intervention in the presence of the metastasis is carried out to remove the entire thyroid gland with nearby fatty tissue. Only the total removal of the gland will protect the person from the disease recurrence.

Upon detection of median cysts of the neck should conduct a histological study of the cellular composition through the biopsy. Histological analysis will help to exclude or confirm malignant pathology.

A thyroid nodule with irregular indistinct contours, pronounced reduction in echogenicity and microcalcifications is a pathognomonic sign of malignant disease. The complete lack of bezel "halo" refers to the spread of tumor outside of thyroid gland tissue. Microcalcifications indicates the development of papillary thyroid cancer. In some cases during the ultrasound the use of Doppler method it is possible to detect enhanced blood flow in the thyroid gland, which indicates active tumor growth.

In case of detection of warning signs on ultrasound necessary to conduct a fine-needle biopsy of the node. Only in the light of the data obtained histological examination solves a question on expediency of surgical intervention. It is not excluded the presence of questionable signs and non-cancerous nodes, changed its structure with long-term existence.

Enlarged cervical lymph nodes with formation of cysts and microcalcifications or the appearance of enhanced blood flow are pretty serious signs, which can indicate the metastasis of thyroid tumor in the area of the lymph node. Increased blood flow in the region of the lymph node may signal the existence of a tumor, e.g., metastasis from cancer in other organs.

Detection of any of the above symptoms should entail an obligation to carry out histological research of biopsy material of the lymph node and examination of swabs taken from the puncture needle, with the aim of determining the level of calcitonin and thyroglobulin. It is important to remember that taking a biopsy of the thyroid gland and lymph nodes should be accompanied by ultrasound monitoring of the direction of the needle.

Here are the images,obtained by ultrasonography study of pathologically changed thyroid gland:

The defeat of the jugular neck lymph node metastasis of papillary thyroid cancer – picture ultrasound The disappearance of the internal structure of the cervical lymph node on ultrasonography in lesions with metastasis of papillary cancer

It must be remembered that even the presence of questionable signs identified during the ultrasound examination of the thyroid gland, is not an indication for prescription of any treatment. To confirm the diagnosis it is necessary to conduct a number of additional diagnostic procedures, for example, measurement of the level of the relevant hormones, determination of tumor marker (calcitonin), histological studies by biopsy.


General comments on the conduct thyroid ultrasound

Frequency research

A topical issue for many people. The recommended frequency of the ultrasound of the thyroid gland is 1 year in the absence of any complaints, and at least 1 time in six months, if there are any complaints. Subject to disturbing indicators of laboratory and clinical studies the frequency of the ultrasound can be increased to several times a week.

Indications for

Thyroid ultrasound may be performed as the next routine inspection, or as one of the most informative diagnostic tests in the presence of certain indications.

Preventive study

Procedure ultrasound usually included in the General list of preventive measures, and is not the result of presenting any complaints to an indisposition. Quite justified are considered a preventive study in people who previously suffered from thyroid disease. The purpose of the ultrasound in this case is to assess the dynamics of the state authority, identify potential recurrences, and also to assess the likelihood of complications.

Diagnostic study

There are situations when thyroid ultrasonography is mandatory for accurate diagnosis.

An ultrasound study is appropriate in the case of any person the following complaints:

  • Visual enlargement of prostate orthe presence of any compacted education in the relevant field;
  • Pain in neck while touching and applying pressure;
  • Swelling and redness of the site of the lateral or anterior surface of the neck;
  • The formation of hoarse voice, difficulty in breathing, the appearance of problems with the act of swallowing;
  • The development of tremor (shaking) of the limbs;

  • The presence of arrhythmia, tachycardia, bradycardia;

  • The development of edema in different parts of the body;
  • The sweating, the increased body temperature, sensation of heat or chill;

  • The development of baldness;

  • Excessive sleepiness, weakness, depressed state, excessive irritability.

The main advantages of the method

If there is a need of selecting the most appropriate and informative method of research of a thyroid condition, you must be familiar with the benefits of ultrasound diagnosis.

The main advantages of this method include:

  • The complete absence of ionizing radiation;
  • Non-invasive (has not disturbed the integrity of the skin);
  • Excluding the possibility of infection;
  • Pregnant women the absence of any effects on the fetus.

Thyroid ultrasonography has no contraindications and is absolutely harmless. This ensures its wide application among pregnant and lactating women as well as children and the elderly. An important advantage of the method is its relatively low cost, availability, and relatively high information content.

Relevance

Extremely important condition is the timely and regular ultrasonography of the thyroid gland. The impetus for its implementation should not become the appearance of certain complaints. Periodic assessment of the thyroid gland allows to prevent and to diagnose the presence of serious diseases, such as benign and malignant neoplasms, the presence of metastasis.

Timely detection of benign neoplastic process allows you to choose the most appropriate treatment strategy to reduce the risk of malignant transformationtumors. Special attention to this method should be given to pregnant women, and those who had undergone gynecological diseases. For example, the presence of hypothyroidism can adversely affect the development process of the fetus. It is better if the disease is detected and treated before pregnancy.

Conclusion

Considering the variety of positive aspects, capabilities of ultrasound study of the thyroid glands are not limitless. For example, the results of ultrasound it is impossible to determine the level of secretion of thyroid hormones, as well as the severity of the autoimmune process. To clarify such details it is necessary to conduct laboratory analysis of blood.

By ultrasonography it is impossible to determine the presence of malignant transformation in tissues of a thyroid nodule. For these purposes, a histological study of biopsy material previously taken.

In any case, when detected visually increase the size of the thyroid gland, and also with the appearance of other of the above symptoms, you should immediately consult a doctor-endocrinologist for further advice and undergoing ultrasound procedures. Timely diagnosis of the disease depends on their outcome and the likelihood of complications.