1. IMAGING OF THE THYROID Dr Jill Hunt Consultant Radiologist West Herts NHS Trust

2. Imaging techniques • ULTRASOUND • Nuclear medicine • CT • MRI • PET/CT

3. WHO TO SCAN? • Clinical goitre • Palpable nodule • Cervical lymphadenopathy • Thyroid lesions on CT/MRI • Thyroid lesions on PET • Not for hyper/hypothyroid patients without palpable abnormality as general rule

4. NODULAR THYROID DISEASE • Multinodular goitre • Adenomas • Colloid nodules • Cysts • Tumours – Papillary, Follicular, Anaplastic, Medullary cell, Lymphoma, Metastases • Thyroiditis

5. DIFFUSE THYROID DISEASE • Grave’s Disease • Hashimoto’s thyroiditis (may be nodular) • Subacute lymphocytic thyroiditis • Subacute viral thyroiditis • Reidel’s thyroiditis • AIT

6. NODULE ASSESSMENT • (Palpable or impalpable) • Solitary or multiple • Size and shape • Echogenicity +/- cystic change • Definition/halo • Calcifications • Vascularity

7. THE PROBLEM –WHICH FOR FNA • Prevalence ~ 5% by palpation • Prevalence of clinically inapparent nodules at US ~ 20-75% • 20-48% patients with 1 palpable nodule have additional nodules on US • ~ 5% of thyroid nodules will be malignant • No. of thyroid cancer cases in UK in 2007 - 2108

9. Benign lesion with spongiform appearance

10. Colloid nodule

11. Papillary carcinoma

12. Anaplastic carcinoma

13. CLINICALLY SUSPICIOUS FEATURES • Hx of head/neck DXT • FHx of MTC, papillary ca or MEN Type 2 • Age <14 or >70 • Male • Growing nodule • Firm/hard/fixed nodule • Cervical lymphadenopathy • Persistent dysphonia/dysphagia/dyspnoea

14. NUCLEAR MEDICINE

15. CT OF THE THYROID

16. MRI of a papillary carcinoma

17. CT/PET of the thyroid

18. CONCLUSION • Ultrasound +/- FNA remains the mainstay of thyroid imaging • Nuclear medicine still has limited role • CT, MRI and CT/PET small number of specific indications