Ultrasound imaging was done which revealed:
Ultrasound: The mass is large, solid, and wider than tall. It is mildly inhomogeneous in echotexture, meaning that it has a slightly different echogenicity (brightness) throughout. There are no calcifications within the mass.
Color Doppler: The mass shows moderate internal vascularity, meaning that there is a moderate amount of blood flow within the mass. This is a nonspecific finding, and it can be seen in both benign and malignant thyroid nodules.
The ultrasound and color Doppler imaging findings in this case are consistent with a benign thyroid nodule, such as a thyroid adenoma. However, the findings are not definitive, and a fine-needle aspiration biopsy (FNAB) is usually needed to make a definitive diagnosis.
Here is a table summarizing the ultrasound and color Doppler imaging findings in this case:
The differential diagnoses for a 20-year-old female patient with a large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid include:
* Thyroid adenoma: This is the most likely diagnosis, especially given the patient's age. Thyroid adenomas are benign tumors that can grow to a large size. They are usually non-functional, meaning that they do not produce excess thyroid hormone.
*Thyroid malignancy: This is a less likely diagnosis, but it is still possible. Thyroid cancer is more common in older adults, but it can occur in younger people as well. The ultrasound findings of moderate internal vascularity and no calcifications are more consistent with a benign tumor, but they are not definitive.
* Lymphoma: This is a rare diagnosis, but it is still possible. Lymphoma can involve the thyroid gland, and it can present as a large solid mass.
*Metastatic cancer: This is also a rare diagnosis, but it is possible. Metastatic cancer to the thyroid gland can occur from other cancers, such as lung cancer or breast cancer.
Final diagnosis: thyroid adenoma
Either papillary or follicular thyroid adenoma.
TIRADS grade for this case is 3:
The Thyroid Imaging Reporting and Data System (TIRADS) is a system used to grade thyroid nodules based on their ultrasound characteristics. The TIRADS grades range from 1 to 5, with 1 being the lowest risk and 5 being the highest risk.
The criteria for TIRADS 3 are as follows:
Size:Greater than or equal to 1 cm but less than or equal to 4 cm.
Shape: Irregular or lobulated.
Echotexture: Hypoechoic or isoechoic.
Calcifications: None.
Vascularity: Moderate.
The patient in this case meets all of the criteria for TIRADS 3, so her nodule would be graded as 3. This means that the nodule has a slightly increased risk of being cancerous, but it is still more likely to be benign.
The management approach for a 20-year-old female patient with this large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid will depend on the final diagnosis. If the diagnosis is a thyroid adenoma, the patient may be monitored with ultrasound every 6-12 months. If the diagnosis is thyroid cancer, the patient will need surgery to remove the tumor. The prognosis for thyroid cancer is generally good, especially if the cancer is caught early.
Further investigations:
The following are some additional tests that may be ordered to help make the diagnosis:
* Thyroid function tests: These tests will measure the levels of thyroid hormone in the blood.
* Fine-needle aspiration biopsy: This is a procedure in which a needle is inserted into the mass to remove a small sample of tissue. The tissue sample is then examined under a microscope to look for cancer cells.
* Thyroid nuclear scan: This is a test that uses radioactive iodine to image the thyroid gland. The scan can help to determine the size and location of the mass, and it can also help to determine if the mass is taking up iodine, which is a characteristic of thyroid cancer.
The prognosis: for a 20-year-old female patient with this large solid mass of 2 x 2.5 x 4 cms filling the entire right lobe of thyroid depends on the final diagnosis. If the diagnosis is a thyroid adenoma, the prognosis is excellent. If the diagnosis is thyroid carcinoma, the prognosis depends on the stage of the cancer and the patient's age and overall health. However, the prognosis for thyroid carcinoma is generally good, especially if the cancer is caught early.
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