PAPILLON COURSE on THYROID ULTRASOUND

 

Case of the Month

October 2024 - case 3

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Summary and comments

I apologize because I did not make clear which lesion is in question in the right lobe and it could cause some confusion for the readers. Therefore, I did not present the distribution of answers only my comments. These rely on the lesion in the lower pole of the right lobe which is brighter than the extranodular part.

1. How would you consider the echogenicity of the nodule?

Expert comment

The answer depends on the reference tissue. If it would be the non-nodular part, then the lesion is clearly brighter, therefore iso/hyperechoic. However, in this patient, the extranodular part is hypoechoic due to the underlying Hashimoto's thyroiditis. In such lesions, the suggestions of the 2023 European guideline, i.e., the normal healthy thyroid would be the reference, making our judgement different. Compared to a healthy thyroid, this nodule is darker, i.e. this must be regarded as a hypoechoic lesion. Compared to the strap muscle running ventral to the thyroid, the lesion is brighter, so, this is a minimally/moderately hypoechoic lesion.

2. What intranodular echogenic figures does the nodule have?

Expert comment

The nodule has some pale echogenic lines which correspond to the normal connective tissue backbone of the thyroid.

3. What suspicious characteristics does the nodule have?

Expert comment

There are two non-pathological causes of the irregularity of the borders. The first is thyroiditis which infiltrates the nodule and makes the borders non-regular. The second - maybe the consequence of the former - is that the lesion seems to be composed of two discrete lesions in certain sections. Both processes make the borders irregular, however these causes should not be regarded as pathological ones. So, in my opinion the nodule' borders are regular. Regarding the remaining three other possible suspicious characteristics, the lesion does not present any of them.

4. How would you classify the nodule according to EU-TIRADS?

Expert comment

Here, I made another mistake because it did not include in the options, EU-TIRADS 1. It is not evident that this lesion is indeed a pathological nodule, can be a part of the lobe, which is less influenced by the underlying thyroiditis, so EU-TIRADS 1 option must be considered.
If we consider the lesion as a true nodule, then based on the above considerations, I will regard the lesion as an EU-TIRADS 3 one.

 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

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