Ultrasound of the Thyroid Gland

  • Tomislav NovoselEmail author
  • Peter Jecker


Thyroid ultrasound is the most efficient, safe, available, and cost-effective diagnostic method to image and evaluate thyroid nodules and thyroid pathology. It is equally efficient for both diagnosis and follow-up (Ghervan, Med Ultrason 13:80–84, 2011). The goal of this chapter is to present and explain which ultrasound features are the most important in thyroid diagnostics and to show at least one example of each characteristic.


Thyroid Thyroid nodule Goiter Thyroiditis, Graves’ disease Thyroid cancer 

Supplementary material

Video 12.1

Hypoechoic thyroid nodules. This thyroid is normal in size, and the right lobe is without nodules. In the left thyroid lobe, you can see two hypoechoic nodules, the smaller one in the upper pole of the lobe and the larger one adjacent to the carotid artery, which is challenging for the fine needle aspiration biopsy. Both nodules have regular margins and do not look suspicious (MP4 10083 kb)

Video 12.2

Isoechoic thyroid nodule: in this video you can see two nodules, one in the isthmus with a spongiform appearance and the second in the right thyroid lobe. The nodule in the right lobe is isoechoic with “halo” effect (hypoechoic rim around the nodule) with peripheral rim of flow. At the medial end of the nodule, posterior acoustic shadowing of a coarse calcification is also seen (MP4 23025 kb)

Video 12.3

Thyroid with partly cystic nodule. This video shows two thyroid nodules, one in the left lobe and one in the isthmus. Both nodules are partly cystic and partly solid. The larger one, in the left lobe, is predominantly solid. At the end of the examination, color Doppler shows that both nodules have negative blood flow (MP4 16222 kb)

Video 12.4

Colloid cyst of the right thyroid lobe: at the medial border of the right thyroid lobe, just adjacent to the isthmus, is visible this hypoechoic/anechoic thyroid nodule with many comet-tail signs (reverberation artifact) representing colloid, typical for a colloid cyst (MP4 28860 kb)

Video 12.5

Thyroid nodule with suspicious ultrasound characteristics. This large nodule of the right thyroid lobe is heterogeneous with irregular margins and coarse calcification (hyperechoic areas), with posterior acoustic shadowing behind the calcification. Between the coarse calcifications, microcalcifications are also visible, as highly hyperechoic small dots without posterior acoustic shadowing. High suspicion for malignancy (MP4 26459 kb)

Video 12.6

Fine needle aspiration biopsy of a suspicious thyroid nodule. This video shows fine needle aspiration biopsy (FNAB) of a large, heterogeneous thyroid nodule of the right thyroid lobe with ill-defined margins. A 21-gauge needle and syringe are used, with a lateral approach through strap muscles toward the trachea. The needle is seen as a lineal and hyperechoic form moving in different directions to collect samples from various parts of the nodule to get a more representative specimen (MP4 41898 kb)

Video 12.7

Color Doppler and elastography examination of a thyroid nodule. In this thyroid gland is seen a heterogeneous, partly cystic thyroid nodule in the isthmus. All margins are well-defined. For further investigation, color Doppler shows increased intrinsic blood flow of the nodule; then elastography shows that it is predominantly hard (blue) (MP4 49144 kb)

Video 12.8

Hashimoto thyroiditis. The thyroid is normal in size, with a lot of diffuse, chronic ultrasound features typical for Hashimoto thyroiditis, including many small hypoechoic areas or fields with hyperechoic lines representing fibrosis, without thyroid nodules (MP4 8141 kb)

Video 12.9

de Quervain’s thyroiditis (right thyroid lobe): the whole thyroid lobe is diffusely changed. There are many hypoechoic areas separated by hyperechoic thyroid tissue, without thyroid nodules. At the end of the examination, color Doppler shows increased internal blood flow (MP4 46459 kb)

Video 12.10

Thyroid cancer: hypoechoic, heterogeneous thyroid nodule at the border between the isthmus and the left thyroid lobe. This nodule has irregular margins, which are especially ill-defined at the upper end of the nodule close to the strap muscles. Highly suspicious for malignancy, which was proved with fine needle aspiration biopsy and the pathology report (MP4 48029 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology and Plastic Head and Neck SurgeryKlinikum Bad Salzungen GmbHBad SalzungenGermany

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