An ultrasound examination of the thyroid gland

An ultrasound examination of the thyroid gland is a non-invasive, safe and very informative method of examination, which has now become an integral part of the examination conducted by an endocrinologist.

Until recently, diagnostic ultrasound was rare and not widely available in clinics. Endocrinologists had to use methods of physical examination in order to detect thyroid pathology. As practice has shown, even with a good performance of physical examination skills and extensive clinical experience, it is impossible to identify a significant part of thyroid diseases.

The ultrasound technique is a very informative tool that enables doctors to differentiate the pathology of the thyroid gland from the neck pathology if a patient complains about: discomfort in the anterior surface of the neck; a feeling of pressure; a persistent sensation of a lump in the throat; pain in the thyroid gland; and difficulty in swallowing. The symptoms associated with thyroid disorders are so diverse and non-specific that almost every patient can be recommended to be examined by an endocrinologist. In such cases, only a thyroid ultrasound can find or exclude the cause of discomfort and complaints.

When using diagnostic ultrasound in combination with a physical examination, an endocrinologist: receives an opportunity for early diagnosis of nodular pathology of the thyroid gland; identifies developmental abnormalities of the thyroid gland; differentiates conditions; and makes an approximate prognosis of the course of the disease. Also, an endocrinologist can explain to the patient how the disease can progress and how to live with it.

Diagnostic ultrasound is indispensable for the early detection of malignant tumours of the thyroid gland. Only large thyroid nodules can be detected by physical examination, which may be a delayed diagnosis of thyroid cancer.

Currently, it is impossible to imagine an examination of patients after surgery on the thyroid and parathyroid glands without regular ultrasound monitoring. In order to detect early cancer cell spread, it is especially important to conduct a regular and timely ultrasound examination of the lymph node after the patient’s recovery from thyroid cancer. It is essential that a person who has undergone surgery for advanced thyroid cancer should be monitored for a long time by a specialist who is well-versed in the anatomy of the neck and skilful in ultrasound examination of peripheral lymph nodes.

When reading the ultrasound protocol, attention should be paid to the location of the gland, its contours and tissue structure. The echogenicity of tissue, organ or tumour frequently causes concern for patients.

Echogenicity is the ability of an anatomical structure to transmit ultrasound. A sonogram of the organ is produced, taking into consideration this feature.

Linear dimensions and volumes of each lobe and the entire gland must be indicated in the ultrasound protocol of the thyroid gland. It is obligatory to describe the structural changes in the tissue that characterise certain thyroid diseases. A description of the ultrasound features of pathophysiological changes is necessary for further dynamic assessment of the organ function when prescribing conservative therapy.

It is especially important to pay attention to the description of thyroid nodules. When describing a node, it is important to: indicate its location in the thyroid lobe or isthmus; evaluate its contours and position of the node relating to the body surface; and describe inclusions and blood flow. By combining certain ultrasound signs, a doctor may suspect lymph node malignancy. However, it should be noted that there are no reliable absolute ultrasound signs that unambiguously indicate node malignancy.

The TIRADS (Thyroid Imaging Reporting and Data System) classification was developed to stratify the risk of malignancy of thyroid nodules. Due to this classification, ultrasound specialists, endocrinologists, fine needle biopsy specialists, and endocrine surgeons understand each other well. They can develop a clear strategy for monitoring, examination and subsequent treatment.

A regular ultrasound examination should be performed yearly if structural changes in the thyroid gland are detected. Adults with chronic thyroiditis and thyroid nodules must follow this rule. As for children, an ultrasound examination of the thyroid gland can be conducted once every six months. When examining a patient, the doctor determines how often diagnostic ultrasound should be performed and substantiates the reason for the frequency of examinations.

Thus, ultrasound examination of the thyroid gland at various levels of medical care can be both a screening technique and a highly informative diagnostic technique for complex neck disorders.