An interesting thyroid ultrasound scan

A young adult female patient presented with non specific complaints of lethargy and weight gain. 

Ultrasound imaging of the thyroid revealed these findings:

Inhomogenous echotexture of thyroid:

Mild increase in vascularity of thyroid: s/o chronic stage of Hashimoto's thyroiditis:👇

In addition  a mildly hypoechoic left thyroid isthmic nodule seen, wider than tall, non calcific: 👇

Poor vascularity of the thyroid nodule:

Lesion is wider than tall:

Ultrasound findings:

1. The thyroid gland appears diffusely heterogeneous with fine nodularity. 
2. The colloid nodule in the isthmus of the thyroid measures 0.8 x 0.4 cms in size.
3. Nodule is wider than tall. 
4. The nodule is well-defined, isoechoic, and has a smooth margin.
5. No calcifications or cystic changes are observed within the nodule.
6. There is no evidence of invasion of adjacent structures or lymphadenopathy.

Color Doppler ultrasound findings:

1. The nodule shows mild peripheral vascularity.
2. No central vascularity is observed within the nodule.
3. The surrounding thyroid tissue shows diffuse hypervascularity.

Final diagnosis: Long standing or chronic Hashimoto's thyroiditis with isolated benign colloid nodule isthmus of thyroid. 

Management:

In cases of Hashimoto's thyroiditis with a small colloid nodule, close observation with regular follow-up is recommended. The patient should undergo periodic ultrasound examinations to monitor the size and morphology of the nodule. Fine-needle aspiration cytology (FNAC) may be performed if any future there are suspicious features such as increased vascularity, irregular margin, or microcalcifications. If the FNAB results are inconclusive or suggestive of malignancy, a diagnostic lobectomy or total thyroidectomy may be performed.

Prognosis:

The prognosis of Hashimoto's thyroiditis with a small colloid nodule is generally favorable, as most nodules are benign. However, the risk of malignancy increases with larger nodule size, irregular margins, and increased vascularity. Regular follow-up and close observation are important in identifying any changes in nodule characteristics that may indicate malignancy. Overall, the prognosis is good in this patient. 

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Ultrasound imaging of thyroid