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What is a neck ultrasound for the thyroid?


A neck ultrasound is a radiologic examination of the neck that uses sound waves (not radiation) to evaluate the size of the thyroid and the presence of nodules or lymph nodes in the region of the thyroid. A thyroid ultrasound is painless, noninvasive, and inexpensive. If they are enlarged, parathyroid glands can also be seen on an ultrasound. Typically, thyroid nodules over 1 cm need to be biopsied to ensure that they are benign. Certain nodules like cystic (fluid filled) lesions are almost always benign and can be followed without surgery. These cystic nodules can be aspirated (drained) to decrease size if they are causing any symptoms such as compression or pain. They may need a FNA biopsy if they are complex (have solid and cystic areas). Lymph nodes that appear suspicious with areas of calcifications, loss of normal appearance, enlargement, or increased blood supply may also need a biopsy.

What does a thyroid ultrasound look like?

Your thyroid has 2 lobes, one on the left and one on the right, and they are usually symmetric. A normal thyroid gland appears uniform throughout, with all of the areas appearing to have the same color and density on the ultrasound screen. If the ultrasound does not appear uniform then it may be that there are nodules present in the gland.  The majority of thyroid nodules are benign, and they can appear as solid, cystic (fluid filled) or complex (combination of solid and cystic). These nodules can have smooth (less suspicious) or irregular borders (more suspicious), and these characteristics along with others help your doctors determine if a nodule needs to be biopsied.

Why is getting an ultrasound so important before going to surgery for thyroid disease?

Obtaining a thyroid ultrasound before any surgery is recommended by the ATA (American Thyroid Association) as an integral part of patient care, which includes determining the extent of disease present and best type of surgery that is needed.

In patients with PTC (papillary thyroid cancer) there is a risk of lymph node cancers as high as 30-50% at the time the diagnosis is made. These lymph nodes are measured best and assessed with neck ultrasound before surgery. It has been shown that recognizing neck lymph nodes with cancer before surgery and then treating with an appropriate operative resection lowers the risk of local recurrence (cancer coming back). It is the most effective means to decrease disease recurrence long term.

A neck ultrasound can help locate an abnormal parathyroid gland or even multiple glands. Locating these glands before any surgery is done can be helpful to the surgeon, and even allow for a more “minimally invasive” surgery if appropriate (a small scar surgery).

Also, approximately 2/3rd of patients with parathyroid disease will also have thyroid nodules at the same time. It is important to address both the thyroid and parathyroid before any neck operation, as there is a chance necessary surgery may be done on both glands during the same operation. Dr. Brady performs preoperative neck ultrasounds when appropriate during the initial clinic visit.

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