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Sonographic Appearance of Focal Thyroiditis

Jill E. Langer1, Azra Khan1,2, Harvey L. Nisenbaum1, Zubair W. Baloch3, Steven C. Horii1, Beverly G. Coleman1 and Susan J. Mandel4

1 Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104.
2 Prsent Address: Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1x8 Canada.
3 Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, PA 19104.
4 Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104.



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  		Fig. 1. —37-year-old-woman with 3-cm left-sided nodule that proved to be papillary thyroid carcinoma. Sagittal sonogram of right lobe obtained at time of diagnosis of left-sided thyroid carcinoma shows 11-mm hypoechoic solid nodule with ill-defined margins (delineated by electronic calipers) in upper pole of right lobe. Sonographically guided fine-needle aspiration of this nodule and surgical pathology findings were consistent with lymphocytic thyroiditis. Remainder of thyroid has hypoechoic micronodules (arrows), a pattern that has a high positive predictive value for antibody-positive lymphocytic thyroiditis [4, 5].

 


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  		Fig. 2. —54-year-old woman with history of hypothyroidism and palpable left lower pole nodule. Sagittal sonogram of left lobe of thyroid shows solid, predominately hyperechoic, poorly marginated nodule (arrows) in lower pole corresponding to palpable abnormality. Fine-needle aspiration of this lesion was consistent with thyroiditis. Background of thyroid was heterogeneous, with geographic regions of hypoechogenicity (arrowheads).

 


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  		Fig. 3. —64-year-old woman with palpable abnormality on physical examination that proved to be two nodules of thyroiditis on sonography. Fine-needle aspiration of this 28-mm palpable nodule (solid arrows) was consistent with lymphocytic thyroiditis. Nodule was predominantly hyperechoic, with both solid and cystic-appearing (open arrows) components. A second nodule (not shown) was solid and hyperechoic in appearance. Both nodules were consistent with lymphocytic thyroiditis on fine-needle aspiration.

 


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  		Fig. 4. —24-year-old euthyroid woman with solitary thyroid nodule. Sagittal sonogram of left lobe of thyroid shows scattered foci of calcifications measuring between 1 and 2 mm (black arrows) in periphery of this nodule that on fine-needle aspiration proved to be thyroiditis. Background echogenicity was homogeneous and hyperechoic relative to strap muscles. Nodule has partial halo (white arrows).

 


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  		Fig. 5. —64-year-old woman with solitary palpable nodule. Sagittal sonogram of left lobe of thyroid shows solitary 10-mm hypoechoic solid nodule (short arrows) that has central 8-mm linear calcification (long arrow) with distal acoustic shadowing. On fine-needle aspiration this nodule proved to be thyroiditis. Note that background echogenicity of gland is homogeneous and hyperechoic relative to neck muscles.

 

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