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

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

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 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