Diffuse Enlargement – Subacute Thyroiditis

A diffusely enlarged almost homogeneous thyroid gland is seen in the non contrast CTscan of this 78 year old female patient. (a,b,d,e) The thyroid gland measures 8.5cms (craniocaudad), by 3.9cms (A-P) by 4.8cms (transverse). Clinical findings were consistent with subacute thyroiditis, with biochemical findings suggesting hypothyroidism. The ultrasound (c,e) shows an enlarged gland as well with similar dimensions, appearing almost round on the transverse view (c). This rounded shape in the transverse dimension is a clue to the presence of a large and abnormal gland, even before the measurements are evaluated. The gland is mildly heterogeneous particularly well seen on the sagittal view (e). The findings are consistent with a thyroiditis.

Courtesy Ashley Davidoff MD Copyright 2010 94549c04L.8s

Diffuse Enlargement

The CT is from a 75 year old man who has had a goiter for many years. The images reflect diffuse enlargement of the thyroid seen on the scout CXR prior to a CT scan, on the coronal view (b,c) and on an axial scan. The gland is enlarged with each lobe measuring about 12 cms in craniocaudad dimension (length) by 6cms in anteroposterior dimension by 12 cms in transverse dimension. The symmetric widening of the mediastinum seen in (a) is unusual for a retrosternal goiter which tends to affect one lobe more than another. Image (b) shows diffuse enlargement of the gland affecting both sides to almost the same degree, heterogeneous in texture with scattered coarse calcifications, but no obvious discrete nodules. The trachea is narrowed from side to side but is not displaced because of the symmetric involvement which pushes on the trachea from both sides. Image c shows the enlarged gland which maintains its thyroid shape, and again shows heterogeneous enhancing texture with scattered coarse calcifications. Image d reveals the same findings in transverse dimension and again shows the symmetric pressure placed on the narrowed trachea These findings are consistent with a diffusely involved goiter.

Courtesy Ashley Davidoff MD Copyright 2010 94714c01.8

Amyloidosis of the Thyroid

The CT is from a 35 year old man with a complex history including long standing history of Crohn’s disease and a recent history of lymphoma. He has had a goiter for many years and biopsy showed amyloidosis of the thyroid. The image on left is a coronal view of the neck and the b is a transverse view of the thyroid. The gland is enlarged measuring 6.2cms in Craniocaudal dimension (length) by 3cms in anteroposterior dimension by 3cms in transverse dimension. On the transverse view it is not quite round but the gland is full bodied reminiscent of its large size. The density appearance is puzzling. Since no non contrast CT was performed the peripheral increase in density may be due to enhancement or more likely due to iodine or calcification. The soft densities to the right of the right lobe are related to the patients newly diagnosed lymphoma.

Courtesy Ashley Davidoff MD Copyright 2010 94553c.8

B Cell Lymphoma

A large mostly isoechoic enlarged thyroid is demonstrated on the ultrasound of this 64 year female. Images a and b are in the sagittal projection and b and d in the transverse plane. The lobes of the thyroid measure 5.1cms in craniocaudad span by 2.6 cms in A-P dimension by 2.6cms transversely. Note the rounded shape of the right lobe suggesting enlargement of the gland by virtue of shape. The isthmus is also thickened and measured almost a cms. The left lobe had similar size shape and echotexture. The parenchyma is heterogeneous with no nodules (a,b) and Doppler flow is normal (c,d) and unremarkable. A biopsy showed B cell lymphoma

Courtesy Ashley Davidoff MD Copyright 2010 94882c.8