1. Radiology of Thyroid and parathyroid
By Dr Riaz Mohammad
Radiology of Thyroid and parathyroid

2. Thyroid and parathyroid
Normal Anatomy.
Radiological test.
Disease

3. Thyroid and parathyroid
Normal Anatomy
Embryology: Thyroid gland is derived from a tubular structure at the base of tongue called foramen cecum

4. Anatomy Thyroid gland has two elongated lateral lobes.
United in the middle by a median isthmus
It is 4-6 cm in L, cm thick. Isthmus is 6mm thick
Some time a pyramidal lobe is present which extend upward from the isthmus.
Thyroid is supplied by superior and inferior thyroid arteries. It is extremely vascular

6. Thyroid Anatomy
Posterior aspect
Anterior and posterior aspect

7. Thyroid produce T3, T4, and calcitonin.
Parathyroid are two pairs(4 in number) located on the back of thyroid. The superior pair is located near the middle of thyroid and the inferior pair at the lower pole on both side.
Parathyroid are the size of a grain of rice(3-5mm). It produce parathyroid hormone.

11. Normal ultrasound anatomy
Transverse image
Color Doppler image

12. Longitudinal image of LT lobe
Isthmus

13. Imaging modalities used for evaluation of thyroid and parathyroid.
Ultrasound
Radionuclide studies
CT scan
Biopsy Ultrasound/ CT guided

15. Ultrasound technique

16. High frequency sound wave are used
Patient is supine with hyperextended neck
Both right ,left lobes and isthmus are examined
Color Doppler is used to see vascularity
Transverse and longitudinal images are taken
Ultrasound shows anatomical detail of thyroid and adjacent blood vessels and structures.
Normal parathyroid can not be seen with U/S, however parathyroid adenoma and cervical nodes involved in thyroid cancer can be sampled

18. Radioisotopes study A radionuclide is injected or given orally.
Radioisotope taken up by thyroid/parathyroid
Patient is put under the gamma camera to see the uptake
Series of images are taken in different projections
Radionuclide studies show function. Anatomical details are poor.

19. Gama camera

20. Normal
Normal

21. CT images of thyroid
CT shows clear anatomy of thyroid gland. Test is done without and with contrast

22. Diseases of thyroid Functional disorders. 1. Hyperthyroidism
2. Hypothyroidism
Inflammations. 1.Hashimoto 2. Sub acute etc.
Nodular disorders simple goiter
2. Multinodular goiter
Tumors. 1. Adenoma
Carcinoma-Follicular, papillary, Medullary, anaplastic, hurthle cells and secondary

23. Hyperthyroidism and gravis disease
Hyper functioning thyroid gland
Gravis disease occur in young women. Thyroid gland is hyper functioning and hypervascular

28. Inflammations
Hashimoto thyroiditis is an autoimmune inflammation. The gland may be hyper functioning or hypo functioning
In the these images the gland is diffusely enlarge and inhomogeneous
In the image below there is abscess formation in the gland

29. Tumors Adenoma is benign tumor. It is hypo echoic well-defined
Carcinoma. Hypo echoic, irregular and infiltrate in to the surrounding tissues.
On radionuclide imaging carcinoma is usually cold nodule(no uptake)

31. Ultrasound guided biopsy

32. Parathyroid
Adenoma: is a benign lesion . It is well defined and hypo echoic. It is usually associated with hyperparathyroidism
Parathyroid carcinoma. Aggressive lesion irregular hypo echoic. Diagnosis is confirm by biopsy

33. Thank you