Lesson 1C

Question 1

What is US a valuable diagnostic tool in assessing? (9)

Answer 1

1. Classification of a palpated lump
   - eg solid, cystic, mixed
2. Evaluate adjacent structures
3. Determining the location of a palpable lump
   - within or outside of the thyroid
4. Identifying a cause forHyperthyroidism
5. Identifying a cause forHypothyroidism
6. Post surgical complications
7. Multi Nodular Goiter (MNG)
   - follow up nodules
8. Guidance of injection, aspiration or biopsy
9. Relationship of normal anatomy and pathology to each other

Question 2

If the patient presents with a neck lump/swelling for investigation, what are common possible diagnoses other than the thyroid? (5)

Answer 2

1. Fat roll at the base of the neck
2. Lymphadenopathy
3. Branchial cleft cyst
   - supero-lateral to the thyroid
4. Thyroglossal duct cyst
   - midline superior to the thyroid
5. Parathyroid gland mass
   - usually small and inferior on the thyroid

Question 3

What are limitations when scanning the thyroid?

Answer 3

The inferior most aspect of an enlarged thyroid with marked retrosternal extension will not always be visible on ultrasound

Question 4

How do you prepare for a thyroid US scan? (5)

Answer 4

1. Low collared shirt
2. Remove jewellery around the neck
3. Towel across the shoulders/chest
4. Lie the patient so their head is at the top of pillow and tipped right back
5. A pillow or towel can be placed under the shoulders

Question 5

What typical transducer do you use to scan the thyroid?

Answer 5

7-14MHz linear transducer

Question 6

When would you use a curvi-linear array transducer of 3.5MHz when scanning the thyroid? (3)

Answer 6

1. Deep seated tumours
2. Retrosternal thyroids
3. Large patients

Question 7

When scanning the thyroid, what do you start with?

Answer 7

Scan in transverse down the midline to assess for tracheal deviation and obvious pathology

Question 8

What is the normal thyroid gland volume?

Answer 8

7-11cc/lobe

Question 9

What images should be taken with the thyroid? (6)

Answer 9

1. Transverse images of the gland from superior to inferior
2. Longitudinal images of the gland with a length measurement
3. Isthmus, trans and long with a maximum AP diameter
4. Left neck
5. Right neck.
6. Assess the paracervical lymph nodes, carotid artery and jugular vein