This is the description of the appearance of the thyroid on ultrasound and is most often seen in thyroiditis or inflammation of the thyroid. Postoperative pathology suggested bilateral metastatic thyroid NENs (Figure3) and the immunohistochemical results showed CK[+], TG[-], TTF1 slightly scattered[+], HBME-1[-], S-100[-], Calcitonin[-], CgA[+], Syn[+], Ki-67[+] 10-20%, CK19 [+], CK20[-], PAX 8[-], CEA[-], CDX2[-] and SATB2[-] (Figure4). Looks like youre visiting UCSF Health on Internet Explorer. good luck to you, I came across this. Thyroid Nodules Diffusely heterogeneous thyroid gland | HealthTap Online Doctor Some studies suggest that more than 50 percent of the population may have a thyroid nodule. Thyroid cancer can be divided into two types according to its cellular origin, i.e., malignant tumors originating from thyroid cells and cancers that metastasize to the thyroid from other sites, the latter of which are, clinically rare. SPot images are available for review. WebThe US patterns were classified into 4 grades to compare the thyroid echogenicity and anterior strap muscle echogenicity, which was used as a reference: Grade 1 (G1): diffusely enlarged gland with a normoechoic US pattern (similar to normal tissue, and to the submandibular gland, hyperechoic to the anterior strap muscle) ( Fig. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. UCSF offers comprehensive consultations and treatments for thyroid conditions, including goiter (enlarged thyroid gland) and thyroid nodules. Can anyone help read my ultrasound results? If they suspect you may have thyroiditis after, theyll likely order any combination of the following tests to help diagnose it: The treatment for thyroiditis depends on the type and the symptoms. You may be able to start with other treatments to avoid developing thyroiditis. From: Surgery of the Thyroid and Parathyroid Glands (Third Edition), 2021, In Diagnostic Pathology: Intraoperative Consultation (Second Edition), 2018, Parathyroid parenchyma can resemble thyroid parenchyma, Pseudofollicular and trabecular structures can be present, Pseudofollicles can contain eosinophilic material that simulates colloid, Oxyphilic cells can resemble Hrthle cell nodule of thyroid, Features helpful to identify true parathyroid parenchyma, Cells smaller and more vacuolated than thyroid cells, Nuclei have rounder and denser chromatin than thyroid nuclei, Lack birefringent and polarizable calcium oxalate crystals seen in thyroid, Pseudofollicles can contain material that closely mimics colloid, Thyroid parenchyma can resemble parathyroid parenchyma, Stromal edema or ice crystal artifact can simulate adipose tissue, Rarely, true adipose metaplasia can be present within thyroid tissue, Hrthle cells of thyroid can be mistaken for oxyphil cells, True thyroid follicles often contain calcium oxalate crystals that are easily seen with polarization, Calcium oxalate crystals are not seen in parathyroid tissue, Ice crystal artifact can mimic adipose tissue within lymph node and mimic parathyroid gland, Parathyroid tissue has more cytoplasm than lymphocytes, Assessing cellularity in small biopsies can be difficult, Variable within parathyroid glands and among glands in single individual, Polar regions of parathyroid more cellular than central, Cellularity increases with age and varies with gender, ethnicity, and body habitus, In Imaging Anatomy: Ultrasound (Second Edition), 2018, Normal thyroid parenchyma has fine, uniform echoes and is hyperechoic compared to adjacent muscles, Echogenic thyroid capsule is clearly visualized and helps to differentiate thyroid lesions from extrathyroidal masses, Both longitudinal and transverse scans are required for comprehensive ultrasound assessment of thyroid gland, Transverse scan helps to locate thyroid nodules, their relationship to trachea, major vessels in carotid sheath, and to evaluate internal architecture and extrathyroid extension, Longitudinal scan helps to evaluate internal architecture, vascularity on Doppler, and extrathyroidal extension, Assessment of adjacent structures (including trachea, esophagus, strap muscles, carotid artery, and internal jugular vein) and cervical lymph nodes, In Diagnostic Pathology: Head and Neck (Second Edition), 2016, Destruction and replacement of thyroid parenchyma by dense collagen (keloid-like bands of fibrosis), Fibrosing process is not confined to thyroid but also involves extrathyroidal connective tissue structures, such as, Muscle, adipose tissue, nerves, and vascular spaces, In addition to fibrosis, chronic inflammatory cell infiltrate is present, Predominantly composed of mature plasma cells and lymphocytes; eosinophils may be present, Vasculitis is present primarily involving veins (phlebitis) characterized by adventitial inflammation that may invade through full thickness of vessel wall with thrombotic effect, May be readily apparent or may be difficult to identify; not present in all cases, Remnant of thyroid follicles may be present (but may be difficult to identify), Not associated with oxyphilic metaplasia (as seen in chronic lymphocytic thyroiditis) or granulomatous inflammation, In some cases, preexisting or coexisting lesions may be present, e.g., adenomatoid nodule(s), follicular adenoma, follicular carcinoma, thyroid papillary carcinoma, Vania Nos MD, PhD, in Diagnostic Pathology: Endocrine (Second Edition), 2018, Reactive histologic features present in thyroid parenchyma, Absence of follicular cells within needle tract in addition to other reactive features indicates PFNAC, Cells with reactive atypia may become dislodged into vessels mimicking appearance of vascular invasion, Andreas Machens MD, PhD, Henning Dralle MD, PhD, in Advances in Treatment and Management in Surgical Endocrinology, 2020, Invasive growth emerges from within the thyroid parenchyma (extrathyroidal extension) or from within the lymphatic mesenchyma (extranodal growth).26 Two types of locoregional soft tissue infiltrates are to be distinguished: (1) by direct extension of, and/or venous microembolization from, a primary tumor penetrating the thyroid capsule, more commonly seen in the central neck; and (2) by growth of lymph node metastases through the nodal capsule, more often found in the lateral neck.27, Primary tumor size >20mm is independently associated with histology-proven lymph node recurrence. WebThe relationship between heterogeneous echogenicity of thyroid gland and thyroid tests are well known. Informed consent was obtained from the participant/patient(s) for the publication of this case report. covering md sent message saying no f/u needed as nodule so small but didn't address #1 finding. Policy. As your symptoms improve, your provider will taper off the medication since the thyrotoxic phase is temporary. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. WebA goiter is an enlargement of the thyroid, the H-shaped gland that wraps around the front of your windpipe, just below your Adam's apple. You still may not be able to avoid thyroiditis. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thyroid Nodules: When to Worry | Johns Hopkins Medicine doi:10.1111/his.14246, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Subclinical hypothyroidism: Elevation of TSH with TH levels within normal range. The current study compared witht he previous examination of 9/13 shows the right lobe to be 6.1x2.1x1.8 cm. Heterogeneous echogenicity of the underlying thyroid STIs are the most common cause of genital sores. I had an ultrasound done on my thyroid today due to a lump/nodule I found. The relationship between ultrasound findings and thyroid - Nature Battistella E, Pomba L, Mattara G, Franzato B, Toniato A. Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience[J]. (D) Cancer cells positive for Syn (Syn; 400X). If youre experiencing these symptoms, call 911 or get to the nearest hospital as soon as possible. Clinicopathological and molecular features of secondary cancer (Metastasis) to the thyroid and advances in Management[J]. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Thyroid gland enlargement is usually diffuse and symmetric. Due to the very low incidence of TM, there are still no guidelines for its treatment. K-NL: Conceptualization, Methodology, Formal analysis, Resources, Writing - Original Draft. In some cases, the pain can be severe and may require steroid therapy. If you have subacute, painless (silent) or postpartum thyroiditis and have hypothyroid symptoms, your provider will prescribe thyroid hormone replacement medication. The result of enteroscopy suggested a rectal mass (Figure2A) and the patient had previously undergone radical rectal resection for a rectal neuroendocrine neoplasm (NEN). Nixon IJ, Coca-Pelaz A, Kaleva AI, Triantafyllou A, Angelos P, Owen RP, et al. WebWhat does diffusely enlarged heterogeneous thyroid gland mean? tired all the time. diagnosis? No bleeding into the HT may show as poorly defined, patchy hypoechoic areas and micronodular patterns consisting of *Correspondence: Ding-cun Luo, ldc65@163.com, These authors have contributed equally to this work, https://doi.org/10.3389/fonc.2023.1024908, Creative Commons Attribution License (CC BY). It is usually in the neck, but sometimes it spreads into the thorax and mediastinum. Thyroid Ultrasound: Diffuse and Nodular Disease A goiter can be smooth and uniformly enlarged, calleddiffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter. If the hypothyroidism is mild and you have few, if any, symptoms, then no medication may be necessary. C-Cells: Neuroendocrine cells dispersed in the thyroid parenchyma. Thyroid 13:1024908. doi: 10.3389/fonc.2023.1024908. 2. What are ill-defined thyroid nodules with diffuse heterogeneous echotexture? Nonshivering thermogenesis: Shunting of energy from substrate (fat, glucose) to heat; driven by the uncoupling protein-1 in brown fat. Front. Chaudhary V & Bano S. Thyroid Ultrasound. Tang Q, Wang Z. Metastases to the thyroid gland: what can we Do?[J]. These include: The presence of heterogenous thyroid echogenicity may reduce sensitivity of detection of thyroid nodules. This usually occurs when the brain produces too much thyroid-stimulating hormone. Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. In conclusion, clinicians should remain alert to the possibility of TM in patients with thyroid nodules and a history of other malignancies to avoid missed diagnosis, misdiagnosis, and delayed treatment. Since the patient had no other distant metastatic lesions, we performed bilateral total thyroidectomy + bilateral central lymph node dissection on October 31, 2018. Correlate with thyroid function studies as needed: Real time imaging of the thyroid gland was performed. Theyre available to help you. Metastatic cancer often occurs in thyroid tissue with existing lesions, such as Hashimotos thyroiditis, nodular goiter, and follicular adenoma. The latest domestic research data in Japan show that rectal NENs account for 53% (10) of all gastrointestinal tract NENs, which is much higher than the rate of 28.6% in the United States (11). WebThe vast majority more than 95% of thyroid nodules are benign (noncancerous). 2020 Nov;58 (6):1041-1057. doi: 10.1016/j.rcl.2020.07.003. WebEnter the email address you signed up with and we'll email you a reset link. Epidemiologic trends of and factors associated with overall survival for patients with gastroenteropancreatic neuroendocrine tumors in the united States[J]. World J Clin cases (2020) 8(19):458894. We offer this Site AS IS and without any warranties. Unfortunately, most cases of thyroiditis cant be prevented. What Does It Mean If Your Thyroid Is Heterogeneous? BMC Cancer. In contrast to the above conclusions, the ultrasound images of this patient showed isoechoic nodules with clear boundaries, a regular shape, an uneven solid halo around the edge, and poor blood flow, which may be related to the different characteristics of the primary tumor. Wang X, Huang Y, Zheng Z, Cao W, Chen B, Wang X. Metastases to the thyroid gland: a retrospective analysis of 21 patients[J]. new u/s diffusely n moderately inhomogeneous. Heterogeneous thyroid echotexture | Radiology Reference Article Thyroid glands are diffusely heterogeneous with generalized increased vasculanity? I have nit seen the scan. Multifocal papillary thyroid cancer: This form of cancer, occasionally familiar, is not associated with a more aggressive course. We do not endorse non-Cleveland Clinic products or services. Unable to process the form. doi:10.1111/j.1365-2265.2007.02773.x, Keywords: neuroendocrine tumor, neoplasm metastasis, thyroid gland, rectal cancer, FNA, Citation: Zhang Y, Lin B, Lu K-n, Teng Y-p, Zhou T-h, Da J-y, Wu F, Pan G and Luo D-c (2023) Neuroendocrine neoplasm with metastasis to the thyroid: a case report and literature review. Moreover, swollen and hard lymph nodes could be palpated on both sides of the neck, with a maximum size of approximately 2.0*1.0 cm. Rapid heart rate (tachycardia) that can exceed 140 beats per minute. The data of 11,329 patients with NENs in the US SEER database between 1988 and 2012 showed a distant metastasis rate of 2% for tumors with a diameter 10 mm, 2.4% for those with a diameter 11-19 mm, and 12% for those with a diameter 20 mm. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Full thyroid function recovery from postpartum and silent (painless) thyroiditis also takes about 12 to 18 months. (C) Cancer cells positive for CgA (CgA; 400X). I feel like lead!!!! Lymph node metastases limited to the ipsilateral lateral compartment denote localized disease amenable to surgical cure by systematic neck dissection. Straccia P, Mosseri C, Brunelli C, Rossi ED, Lombardi CP, Fadda G, et al. In May 2017, the patient underwent enteroscopy because bloody stools for 8 months and aggravated for the last 2 months. Homogeneous echotexture,what does that mean? doi:10.1245/s10434-016-5683-4, 26. doi:10.1089/thy.2010.0154, 21. Thyroiditis can lead to over- or under-production of thyroid hormone. doi:10.1007/s12022-017-9475-6, 17. Differences in colour, shape, and size GP: Resources, Data Curation, Writing - Review & Editing. No nodules were seen. Worldwide, the most common cause is not enough iodine in the diet. Additionally, some cases are caused by thyroid cancer, although this is rare. The patient failed to continue chemotherapy due to personal reasons, and no abnormalities were found in subsequent reexaminations. doi:10.1016/j.ejso.2021.02.018, 22. Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade[J]. WebGoiter is a diffuse or localized thyroid gland enlargement.1It is more common in women and is associated with an increase in thyroid hormones and, subsequently, an increase in TSH, which causes the enlargement of the thyroid tissue. This study aims to improve clinicians ability to diagnose and treat TM and improve patient survival rate and quality of life. (C) Ultrasound showed that there was an isoechoic nodule in the right lobe of the patient, approximately 1.5*1 cm in size, with a regular shape and an uneven halo around the edge. The postoperative pathology showed that the endocrine tumor of the rectum was a well-differentiated neuroendocrine tumor, WHO grade 2 (G2), stage IIIB. Can you help me . If you take prescription drugs that can cause thyroiditis, talk to your provider about your risk and if you can stop taking them. A report by Beutner U (26) also posted that the median survival time of TM patients with renal cell carcinoma was 6.5 years after active surgical treatment, while the median survival time of TM patients with other primary tumors was only 4.7 years after surgical treatment. Thyroid (2012) 22(3):25868. If the patient has multiple systemic metastases, treatment should be considered according to the primary lesion and the site of metastasis. Diffuse Thyroid Disease (DTD) and Thyroiditis | Radiology Key By continuing you agree to the use of cookies. thyroid A 56-year-old woman presented with neck pain 1 month after the discovery of a thyroid nodule that developed 1 year prior. (A) Rectal neuroendocrine tumors are indicated by white arrows, and normal thyroid epithelial cells are indicated by black arrows (HE; 100X). However, Papi G (27) believed that the overall survival time of cancer patients was not correlated with the presence or absence of TM. Xu Z, Wang L, Dai S, Chen M, Li F, Sun J, et al. Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). For patients considering surgery, UCSF offers less invasive approaches that leave either no scar or a small scar hidden under the chin. J Cancer Res Ther (2018) 14(7):15158. Of note, the number of lymph node metastases (110; 1120, >20) is connected to the frequency of distant metastases (3%4%, 13%, and 26%30%) mainly to the lung, the axial skeleton, and the liver.30, Presence of thyroid parenchyma in setting of ovarian teratoma, Thyroid tissue represents only minor component of ovarian teratoma, Ovarian teratomas in which thyroid tissue is predominant (at least 50%) or sole tissue component, Thyroid tissue from SO that spread to peritoneum forming peritoneal implants, Ovarian tumor includes presence of thyroid tissue admixed with carcinoid tumor, In this setting, other teratomatous elements usually absent, Malignant ovarian teratomas in which malignant thyroid tumor [usually papillary thyroid carcinoma (PTC)] is intermixed or originating from thyroid tissue in SO, MSO are rare tumors that arise from ectopic thyroid tissue in ovary (benign SO), Nodules may compress surrounding uninvolved thyroid parenchyma, Papillary projections may be present mimicking carcinoma, Papillae simple, without arborization, and lack complexity as compared to papillary thyroid carcinoma, Cells have rounded basally located nuclei with coarse, dense chromatin, Areas of increased cellularity present throughout parenchyma, Sanderson polsters may be present within follicular lumina, Signet ring type vacuoles may be present in cytoplasm, Nuclei lack nuclear features of papillary thyroid carcinoma, Round nuclei with prominent cherry red macronucleoli, Typical post-FNA site changes common as mass-forming lesions frequently undergo fine-needle aspiration biopsy, Follicular rupture and subsequent colloidal spill may lead to granuloma formation, These areas may appear similar to characteristic granulomas in palpation thyroiditis, Cartilage, squamous, and adipose tissue may be present, L.B. can you help me interpret my ultrasound report? If your thyroid cells are damaged quickly and theres a leak of excess thyroid hormone, you might experience symptoms of hyperthyroidism (overactive thyroid), which include: The hypothyroid phase of thyroiditis can be long-lasting and may become permanent. WebDiffusely heterogeneous thyroid gland bilaterally without evidence for discrete dominant nodule. Int J Mol Sci (2022) 23(6):3242. doi:10.3390/ijms23063242, 10. This affects about 5 percent of women in the year after pregnancy. The pain caused by acute infectious thyroiditis and subacute thyroiditis usually can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. The most common form of thyroiditis is Hashimotos thyroiditis, which affects approximately 1% to 2% of people in the United States. In most types of thyroiditis, there are three phases, including: Thyroiditis can affect anyone, but it more commonly affects people assigned female at birth (AFAB) especially adults. If the goiter is large, surgery may still be needed even though the nodule is benign. Background: Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist WebThe various causes of diffuse thyroid disease often have overlapping sonographic imaging features. 2013;13(1):550. Park M, Park S, Kim E et al. Muscle, adipose tissue, nerves, and vascular spaces. These include: thyroid Fibrosing process is not confined to thyroid but also involves extrathyroidal connective tissue structures, such as. I know I should wait to see the doctor, but I picked up my own results. Amante MA, Real IO, Bermudez G. Thyroid metastasis from rectal adenocarcinoma[J]. Can someone tell me what this means? doi:10.3346/jkms.2014.29.10.1432. If you have an autoimmune disease such as Hashimoto's or Graves, sometimes the texture is described as heterogeneous or nodular, indicated the texture varies throughout the thyroid. However, there was no basic thyroid disease in this patient, so the cause of metastasis in this patient needs to be further explored. Diffuse toxic goiter is an autoimmune condition characterized by a diffusely hyperplastic thyroid gland with excessive overproduction of thyroid hormone. doi:10.1007/s42000-020-00255-1, 16. The right lobe measures 3.1 cm in maximal dimension and is diffusely heterogeneous. Us of thyroid diffusely heterogeneous with multiple sub-centimeter nodules, 6mm isthmus, index nodules mixed echo-texture, what does this mean? If youre in the thyrotoxic phase of thyroiditis, your provider may prescribe beta-blockers to decrease palpitations (fast heart rate) and tremors. Clear cell renal carcinoma metastasis mimicking primary thyroid tumor[J]. Heterogeneous echogenicity of the thyroid gland is a non-specific finding and is associated with conditions diffusely affecting the thyroid gland. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. I won't worry much. Call back and ask. WebThyroid Ultrasound: Diffuse and Nodular Disease Radiol Clin North Am. Mattavelli F, Collini P, Pizzi N, Gervasoni C, Pennacchioli E, Mazzaferro V. Thyroid as a target of metastases. Hippokratia (2018) 22(3):13740. Diagnosis and treatment of metastases to the thyroid gland: a meta-Analysis[J]. It is Thyroid diffusely heterogeneous | HealthTap Online Doctor The median survival time reported in previous literature is 8.8-34.0 months (15, 21, 22), and the five-year overall survival rate is 11%-58% (1, 23, 24). TM has an insidious onset and often has no obvious clinical symptoms. Thyroiditis represents a group of conditions that cause inflammation of your thyroid gland. In conclusion, the diagnosis of TM should be based on ultrasound, FNAC and the patients past medical history.