High Resolution Imaging

DMS 202
What is High Resolution Imaging?

• High frequency transducer

• 7.5-15.0 MHz
• Linear array
• Superficial structures
• Depth vs Resolution trade-off
• High definition images
Thyroid and Parathyroid glands

• Overview
• Anatomy
• Physiology
• Congenital anomalies
• Other diagnostic tests
Anatomy of the Thyroid Gland

• Located in anteroinferior neck at

level of thyroid cartilage
• Right and left lobe
• Connected by isthmus
Anatomy of the Thyroid Gland

• Straddles trachea anteriorly

• Bounded laterally by carotid arteries
and jugular veins
• Pyramidal lobe arises from isthmus

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Size

• Lobes normally equal in size

• Normal adult thyroid:
• 4-6 cm long
• ≈ 2-3 cm AP and width
• Vol ≈ 10-15 mL
• L x W x AP x 0.52 radcalculators.org/thyroid-volume-calculator/

• Isthmus: ≈ 0.5 cm AP
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 Relational Anatomy

• Anterior surface:
• Strap muscles
• Sternothyroid
• Omohyoid • Posterolaterally
• Sternohyoid • CCA
• sternocleidomastoid muscle • Internal jugular v.
• SCM, larger oval band, anterior and • Longus colli muscle
lateral to gland
• hypoechoic Δ structure adjacent to
cerv vertebrae

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 Relational Anatomy

• Medial anatomy
• Larynx/ trachea
• Esophagus
• a midline structure, seen on either side
• target appearance in trv
• moves when pt swallows
• Posterior to lobe
• superior and inferior parathyroid glands

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@salus_sonography
 Blood Supply

• Thyroid gland has rich vascularity on

Doppler
• Two superior thyroid arteries
• from external carotids
• Two inferior thyroid arteries
• thyrocervical trunk of subclavian a.
• Corresponding veins drain into
internal jugular veins

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 Thyroid Physiology
• Functions:
• Maintains normal body metabolism,
growth, and development by synthesis,
storage, and secretion of thyroid
hormones
• Utilizes iodine to synthesize hormones
• triiodothyronine - T3
• and thyroxine - T4
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• When thyroid hormone needed by
body, it is released into bloodstream
• thyroid-stimulating hormone (TSH),
produced by pituitary gland regulates the
release
• 3rd thyroid hormone
• calcitonin
• decreases concentration of Ca2+ in blood
 Euthyroid • When thyroid is producing correct amount of thyroid hormone
• Normal, or euthyroid

Hypothyroidism Hyperthyroidism
• Undersecretion of thyroid hormones • Oversecretion of thyroid hormones
• m/c thyroid disorder
• Causes • Cause
• low intake of iodine (goiter) in body • overproduction of hormone from
• inability of thyroid to produce enough • diffuse enlargement of thyroid
hormones • or by neoplasm (such as adenoma)
• pituitary gland that doesn’t control
thyroid production
• Treated with synthetic thyroid hormones
Hypothyroidism / Myxedema Hyperthyroidism

• S/S • S/S
• Decreased metabolic rate • Increased metabolic rate

• Weight gain • Weight loss

• Hair loss • Increased appetite

• Increased subcutaneous tissue around eyes

• High degree of nervous energy
• Tremor
• Lethargy
• Excessive sweating
• Intellectual and motor slowing
• Diaphoresis
• Cold intolerance
• Heat intolerance
• Constipation • Palpitations
• Deep husky voice • Exophthalmos (protruding eyes)
Hashimoto thyroiditis responsible for 75% of Examples of diseases: Graves disease
all hypothyroidism cases and thyrotoxicosis
Common diseases causing Common diseases causing
hypothyroidism hyperthyroidism

• Hashimoto thyroiditis • Graves disease

• m/c cause for hypothyroidism – 75% • m/c cause for hyperthyroidism – 85%
• Endemic iodine deficiency • Toxic multinodular goiter
• Toxic adenoma
Tests of Thyroid Function
• Serum THS – 1st test to be done

Blood test Hyper Hypo Pituitary disease

T4 and T3 High Low Low
TSH Low High Low
 Nuclear medicine or
Scintigraphy
two tests for evaluating thyroid function
Iodine uptake scan
• Radioactive iodine (radiotracer) is swallowed
• Thyroid gland starts to accumulate the radiotracer
• The amount of radioactivity in thyroid is
measured multiple times by gamma camera
• Pts with hyperthyroidism have higher % of
radioactivity
• Pts with hypothyroidism have lower % of
radioactivity
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Cold nodule Hot nodule
Thyroid scan
• Similarly, radiotracer is ingested
• Determines hot or cold nodules
• Hot nodules take up excessive amounts of isotope
• hyperfunctioning nodule - appear very dark
• benign
• Cold nodules take up minimal amounts of isotope
• hypo- or nonfunctional nodule
• 85% of nodules are cold
• have malignant potential
 Sonographic Evaluation of the Thyroid: Sagittal

19

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 Sonographic Evaluation of the Thyroid:
Transverse

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 Sonographic Evaluation of the Thyroid

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 Sonographic Evaluation

Isthmus with
measurement

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 Congenital anomalies

• Aplasia
• absence of 1 lobe, isthmus • Ectopic
or entire gland • Posterior to the tongue
• if entire, severe physical • Sublingual
and mental impact • Lingual thyroid
• asymptomatic or dysphagia, dysphonia, dyspnea
• Hypoplasia • Prelaryngeal thyroid
• Underdevelopment of any
• Substernal thyroid
part of gland
• Ectopic thyroid best seen w scintigraphy
 • Nodules
Pathology of thyroid gland • Often times you will have to describe multiple
Documentation nodules (MNG)
1. Location
• E.g. Rt thyroid trv upper
• Lt thyroid sag lateral
2. Measure the nodule L x W x AP
• Sag and Trv 3. Echogenicity – hypo/iso/hyper
• Measurements and volume 4. Content
• Parenchyma • Cystic/ complex/ solid
• Presence of calcifications
• Homogeneous or heterogeneous
5. Borders
• Vascularity of the gland • ill or well defined
• Color/power • Presence of hypoechoic halo
6. Vascularity of nodule
• Color/power/spectral
Parathyroid Glands

• four small parathyroid glands, two embedded in the posterior surface of

each lobe of the thyroid gland
• surrounded by fine connective tissue capsules
Parathyroid Glands
The positions of the parathyroid glands and their related structures,
viewed from behind.
Parathyroid Glands

• parathyroid glands secrete parathyroid hormone (PTH, parathormone)

• main function of PTH is to increase the blood calcium level when it is
low
• blood calcium levels fall, secretion of PTH is increased and vice versa

• Patients with hypercalcemia can be investigated with US for presence of

parathyroid adenomas
 Parathyroid Glands
• Parathormone and calcitonin from the thyroid gland act in a complementary
manner to maintain blood calcium levels within the normal range
• Needed for:
• muscle contraction
• nerve transmission
• blood clotting
• normal action of many enzymes.
Diagnostic Procedures

• Fine Needle Aspiration

• FNA is the procedure of choice in the evaluation of thyroid nodules - high accuracy
• decreased unnecessary operative procedures in patients with benign nodules
• increased the probability that surgery will be performed on those with malignant
disease.
• FNA of thyroid nodules can be used to categorize tissue into the following categories:
malignant, benign, thyroiditis, follicular neoplasm, suspicious, or non-diagnostic
FNA
FNA