Radiology Lectures | Radquarters

Ultrasound of Hashimoto’s Thyroiditis

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In this radiology lecture, we review the ultrasound appearance of Hashimoto’s thyroiditis with three unique cases!

Key teaching points include:

  • Normal thyroid gland isthmus measures less than 0.4 cm, transverse and AP lobe diameters measure less than 2 cm.
  • Hashimoto’s thyroiditis is an autoimmune thyroiditis caused by antibodies to thyroid proteins.
  • Most common in middle-aged females.
  • May coexist with other autoimmune disorders: Lupus, rheumatoid arthritis.
  • AKA chronic autoimmune lymphocytic thyroiditis: Gland is infiltrated with lymphocytes and plasma cells, fibrotic reaction replaces normal parenchyma.
  • Leads to hypothyroidism = Most common cause in USA.
  • Increased risk of thyroid cancer, including thyroid lymphoma.
  • On ultrasound, gland is normal-sized or enlarged in initial phase with heterogeneously hypoechoic parenchymal echotexture.
  • May have hypoechoic micronodules (1-6 mm) yielding a “pseudonodular” or “giraffe” pattern = High positive predictive value.
  • Can also present with thin echogenic fibrous strands, lobulated contour, and geographic hypoechogenicity without discrete nodules.
  • Gland may be atrophic in chronic cases.
  • Variable color Doppler flow, may be hypervascular.
  • Reactive, morphologically-normal neck nodes may be present.
  • Can be difficult to differentiate from other forms of thyroiditis on ultrasound.
  • Laboratory/serologic diagnosis: Thyroid function tests (TSH, free T4 test), thyroid peroxidase (TPO) antibodies present in most (95%) patients, and antithyroglobulin antibodies.
  • Treatment: Thyroid hormone replacement if hypothyroid.

    • To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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    Radiology Lectures | RadquartersBy Daniel J. Kowal, MD
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