1. Introduction to the thyroid ultrasound – the thyroid in unusual location, non-thyroidal elements is the thyroid region T. Solymosi www.thyrosite.com 2016

2. 2. Sylabus The thyroid as a whole The various patterns of echo abnormalities The significance of the hypoechogenic thyroid What is a nodule? Which nodules have to be described? How to describe a nodule? The retrotracheal and the substernal spread The ectopic thyroid Non-thyroidal elements in the region of the thyroid the parathyroid lymph nodes in the neck other structures

3. Non-thyroidal elements in the region of the thyroid – aberrant thyroid The thyroid descends from the base of the tongue Thyroid tissue may be located practically anywhere in the middle third of the neck The pattern of the ectopic thyroid is usually similar to that located in normal position The occurrence of carcinoma is significantly greater in aberrant tissue Perform aspiration cytology if suspicious (wash-out thyroglobulin)

4. The right thyroid, horizontal view The right thyroid, lonngitudinal view Above the thyroid, horizontal view Above the thyroid, longitudinal view

5. Horizontal view Longitudinal view Horizontal view Longitudinal view

6. Horizontal view Longitudinal view, color Doppler mode Longitudinal view Longitudinal view, color Doppler mode

7. Horizontal view Lateral to the right thyroid Horizontal view Lateral to the right thyroid

8. Non-thyroidal elements in the region of the thyroid – the parathyroid Usually not visible Thyroid ultrasound examination not involves the detection of parathyroids When do we find a parathyroid? By chance if the parathyroid is enlarged (> 1 cm) In the event of known hypercalcaemia and/or hyperparathyroidism Location of the parathyroids usually dorsal and above and below of the poles of the thyroid not in the usual position in around 25% of cases Ultrasound detection itself is only exceptionally enough to the unequivocal diagnosis isotope scan wash-out and serum thyroglobulin and parathormone determination (10-fold increase)

9. Upper 2/3 of the lobe - horizontal view Lower third of the lobe - horizontal view Longitudinal view - 1 Longitudinal view - 2

10. Before aspiration - horizontal view Before aspiration – longitudinal view After aspiration – horizontal view After aspiration - longitudinal view

11. An intrathyroidal parathyroid adenoma A parathyroid located lateral to the carotid artery

12. Non-thyroidal elements in the region of the thyroid – lymph nodes Depending on the presence of the season lymph nodes in the neck can be detected from 15% to 60% of patients. Search for a lymph node is mandatory in the event of a potentially malignant thyroid nodule Characteristics of a reactive-type benign lymph node regular hilum a homogeneous or minimally inhomogeneous hypoechogenic structure ovoid shape except for the hilum minimal or no intranodal vascularization lack of intranodal hyperechogenic figures Perform aspiration cytology if suspicious (wash-out thyroglobulin)

13. Benign, reactive-type lymph node Metastatic lymph node

14. Benign, reactive-type lymph node Metastatic lymph node

15. Benign, reactive-type lymph node Metastatic lymph node

16. Benign, reactive-type lymph node Metastatic lymph node

17. Non-thyroidal elements in the region of the thyroid – other structures The presence of other structures may cause differential diagnostic problems Normal anatomical findings in unusual position Abnormal, pathological findings Perform aspiration cytology if suspicious (wash-out thyroglobulin)

18. Horizontal view Longitudinal view Horizontal view, color Doppler mode Longitudinal view

19. Horizontal view Longitudinal view Horizontal view – color Doppler mode Histological slide

20. Horizontal view Color Doppler mode