Benign hyperplastic nodules - Case 25

There was an autonomously functioning nodule in the right thyroid (upper images and left lower image). The echogenicity of a toxic nodule is not specific, a relatively greater proportion of such lesion is moderately hypoechogenic or more hypoechogenic than echonormal or hyperechogenic. Most toxic nodules present a halo sign and a combined type 2 and type 3 vascular pattern, i.e. both perinodular and intranodular blood flow. An atrophic contralateral lobe (right lower image in this patient) is also a typical property.

A patient with Marine-Lenhart syndrome. Graves' disease - Case 17

Right lobe

Left lobe

A mixed echonormal-hypoechogenic nodule is presented with a halo sign. Note that the extranodular part of the lobe is hypoechogenic.

This lobe is hypoechogenic and atrophic. The vascularization is increased.

Marine-Lenhart syndrome means the combination of an autonomously functioning adenoma and Graves' hyperthyroidism. The most important sonographic property of this disease is the hypoechogenicity of the extranodular part with increased vascularization. It is very important to recognize the concomittant autoimmune hyperthyroidism in order to initiate the appropriate type of surgery, i.e. bilateral thyroidectomy instead of lobectomy. In most cases without thyroid associated orbitopathy, the toxic nodule comes to the front and we have the best chance to recognize the Graves' disease by thorough analysis of the echo pattern.