thyriod gland hypothyriodism imaging part 4 (hypothyriodism) dr ahmed esawy
TRANSCRIPT
بسم هللا الرحمن
الرحيم
Dr Ahmed Esawy
Dr. Ahmed Eisawy
MBBS M.Sc MD
Dr Ahmed Esawy
HYPOTHYRIODISM
CONGENITAL
Hypoplasia & mal-descent Agenesis ,hemiagenesis Ectopia thyriod (sublingual thyriod) Familial enzyme defects Iodine deficiency (endemic cretinism) Intake of goitrogens during pregnancy Pituitary defects Idiopathic
Iodine deficiency(diffuse giotre) Hashimoto´s thyroiditis (autoimmune thyroiditis)
Subacute (De Quervein’s) thyroiditis
Thyroidectomy or RAI therapy TSH or TRH deficiency Medications (iodide & Cobalt,amiodarone)) Idiopathic Post partum amyliodosis
ACQUIRED
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Thyriod Ultrasound in
hypothyriodism
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Causes of Congenital
Hypothyroidism • Dysgenesis
ectopic thyriod (Sublingual thyroid)
Agenesis
Hypoplasia
Hemiagenesis
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Causes of Acquired
Hypothyroidism
• Postoperative states
• Iodine deficiency (diffuse goitre which often becomes
nodular . The perfusion is normal. Enlargement of the
thyroid gland is an adaptive process in low iodine intake)
• Hashimoto´s thyroiditis (autoimmune thyroiditis)
• Subacute (De Quervein’s) thyroiditis
• Amiodarone-induced hypothyroidism
• Post partum
• Amyliodosis infiltration
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Causes of Acquired
Hypothyroidism
• Postoperative states
• Iodine deficiency (diffuse goitre which often becomes
nodular . The perfusion is normal. Enlargement of the
thyroid gland is an adaptive process in low iodine intake)
• Hashimoto´s thyroiditis (autoimmune thyroiditis)
• Subacute (De Quervein’s) thyroiditis
• Amiodarone-induced hypothyroidism
• Post partum
• Amyliodosis infiltration
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State of thyriod blood perfusion
Perfusion of the thyroid increases on several occasions:
• increased cardiac output (a stressed patient),
• in gravidity,
• during an active autoimmune inflammation – active Graves´ disease or
Hashimoto´s thyroiditis ((in active Graves´ disease “thyroid inferno”).
• hyperfunctioning nodules
• untreated primary hypothyroidism because of TSH stimulation.
decreased perfusion in breakdown of the thyroid tissue – as is the case of
• postpartum thyroiditis,
• De Quervain thyroiditis
• amiodarone-induced thyrotoxicosis type 2.
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• PSV normal up to 25 cm/sec
• PSV at thyrotoxicosis more than 100 cm/sec
• PSV at hypothyriodism 50-60 cm/sec
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Normal thyroid gland : US
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TUS of a diffuse goitre in a
euthyroid patient
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Normal TUS image of left thyroid lobe (euthyroid patient
with negative thyroid autoantibodies). Note the
low perfusion on the Doppler imaging (right).
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Reference Standard for
Thyroid Size (cm) by Age
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10-day-old girl with
sublingual thyroid gland.
.
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14-day-old girl with thyroid agenesis.
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7-day-old boy with thyroid hemiagenesis.
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20-day-old girl with hemiagenesis and sublingual thyroid.
.
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9-day-old boy with thyroid gland in normal location.
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Congenital hypothyroidism
Ultrasound
Aplasia
Hemiagenesis
Lingual thyroid
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Hashimotos thyroiditis
• Destructive autoimmune disorder which
leads to chronic inflammation of gland
• Enlargment not necessarly symmetric
• Young Middle aged female
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Hashimotos thyroiditis
• Three stages
• -Acute : enlarged in size and decreased
vascularity
• Chronic : enlarged with multiple linear
bright echoes throuhout parenchyma with
multiple hypoechioc nodules
• Atrophic : end stage small atrophic gland
,avascular with heterogenous echoes
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Hashimotos thyroiditis
• Sonographic features :
• diffusle enlarged and coarse parenchyma
• heterogenous texture
• Multiple hypoechioc nodules in both lobes
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Hashimotos thyroiditis
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Hashimotos thyroiditis (late stage):
Heterogeneous and coarse parenchyma
• Multiple small hypoechoic nodules surrounded by an echogenic rim of fibrosis
• Vascularity : Variable; increased early in the disease and decreased later in
the disease course
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diffusely coarse echotexture with
innumerable tiny hypoechoic nodules
that may become confluent,
interspersed with echogenic fibrous
bands. Vascularity may be increased,
decreased, or normal, and FNA is
usually not necessary for diagnosis.
painless enlarged thyroid usually
in a hypothyroid state .few in
hyperthyriod state
Hashimotos thyroiditis
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Nodular Hashimotos thyroiditis
Homogeneously echogenic nodule with a hypoechoic rim: “white knight”
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Typical TUS image of Hashimoto´s
thyroiditis (TSH 17 mIU/l, highly positive
thyroid autoantibodies). Note
the inhomogenous and hypoechogenic
thyroid texture.
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TUS image of the right thyroid lobe in a patient with Hashimoto´s thyroiditis with a
large goitre.
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Graves disease
Diffusely enlarged, hypoechoic, increased vascularity (thyroid inferno)
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Graves disease
• PSV HIGH
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Graves disease / Hashimotos thyroiditis
Thyroid
inferno Graves disease: 4 hour uptake of 40%
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Absent thyroid gland in a patient after total thyroidectomy due to papillary thyroid
carcinoma. Note fibrous tissue without residual thyroid parenchyma in the thyroid beds. Dr Ahmed Esawy
atrophic
thyroiditis
TUS of atrophic thyroiditis (a patient with
mild hypothyroidism: TSH 9.43 mIU/l,
highly positive anti-TPO antibodies).
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Subacute (De Quervein’s)
thyroiditis • The inflammation do not involve entire
glan but infiltrates gland in non-
homogenous patteren
• Sonographic feature (hypoechioc and
hypervascular areas)
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TUS image of subacute thyroiditis in the
hyperthyroid phase (FT3: 10.7 pmol/l, FT4:
33.1 pmol/l, TSH: 0.039
mIU/l, antibodies negative). Note the low
perfusion as shown by the Doppler imaging
(right).
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amiodarone
TUS image in a 69-year-old patient who
developed hypothyroidism after treatment
by amiodarone.
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Post
partum
TUS of the left thyroid lobe of patient
with PPT which occurred two months
after delivery .
Four months after delivery, the patient
developed hypothyroidism
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euthyroid
woman
TUS image in a young
euthyroid woman with
negative antithyroid
antibodies
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amyloidosis
TUS image of thyroid amyloidosis
confirmed by cytology
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THANK YOU
Dr Ahmed Esawy