Korean J Radiol.  2015 Apr;16(2):419-429. 10.3348/kjr.2015.16.2.419.

Ultrasonography of Various Thyroid Diseases in Children and Adolescents: A Pictorial Essay

• Hong HS
• Lee EH
• Jeong SH
• Park J
• Lee H

• KMID: 2070186
• DOI: http://doi.org/10.3348/kjr.2015.16.2.419

Abstract

Thyroid imaging is indicated to evaluate congenital hypothyroidism during newborn screening or in cases of a palpable thyroid mass in children and adolescents. This pictorial essay reviews the ultrasonography (US) of thyroid diseases in children and adolescents, including normal thyroid gland development, imaging features of congenital thyroid disorders (dysgenesis, [aplasia, ectopy, hypoplasia], dyshormonogenesis, transient hypothyroidism, thyroglossal duct cyst), diffuse thyroid disease (Grave's disease, Hashimoto's thyroiditis, and suppurative thyroiditis), and thyroid nodules. The primary imaging modalities for evaluating thyroid diseases are US and radionuclide scintigraphy. Additionally, US can be used to guide aspiration of detected nodules.

Keyword

Thyroid disease; Ultrasonography; Children; Congenital hypothyroidism; Nodule; Diffuse thyroid disease

MeSH Terms

Adolescent
Child
Congenital Hypothyroidism/diagnosis/*ultrasonography
Female
Graves Disease/diagnosis/ultrasonography
Hashimoto Disease/diagnosis/ultrasonography
Humans
Hypothyroidism/diagnosis/*ultrasonography
Infant, Newborn
Male
Thyroid Dysgenesis/diagnosis/ultrasonography
Thyroid Nodule/embryology/*ultrasonography
Thyroiditis/diagnosis/*ultrasonography

Figure

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  Fig. 1 Normal thyroid development. A. Thyroid develops from median endodermal thickening in floor of primordial pharynx, between first and second pharyngeal arches. Thickening rapidly leads to formation of small outpouching referred to as thyroid primordium. B. Thyroid primordium is initially hollow but quickly becomes solid and divides into right and left lobes. C. Developing thyroid gland descends in neck. Thyroid gland is connected for short time to tongue by narrow tube (i.e., thyroglossal duct). By seventh week it assumes definitive shape and reaches its final site within neck.

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  Fig. 2 Thyroid aplasia in 29-day-old boy. Thyroid stimulating hormone level was > 95 µU/mL (normal range, 0.25-4.0 µU/mL). A. Transverse ultrasonography (US) reveals hyperechogenic structures (arrows) on both sides of trachea in empty thyroid area, signifying remnants of ultimobranchial body. Refer to Figure 4A for US findings of normal thyroid gland. B. Anteroposterior views of Tc-99m scan confirm absence of detectable thyroid activity, with only background soft tissue and salivary glands visible.

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  Fig. 3 Ectopic thyroid gland in 29-day-old boy. Thyroid stimulating hormone level was 40.66 µU/mL. A. Solid nodular mass (arrows), similar to normal thyroid echogenicity, was present in anterior strap muscle at level of larynx (arrowheads, cricoarytenoid joint) on transverse scan. B. Image of Tc-99m scan shows isotope uptake in upper neck with no uptake in normal thyroid gland.

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  Fig. 4 Transient hypothyroidism in 1-month-old boy born at 36 weeks and weighing 2440 g. Neonatal screening revealed abnormally high thyroid stimulating hormone (TSH) (27.65 µU/mL) and free thyroxine (T4) (1.76 ng/dL; normal range, 0.70-2.0 ng/dL) levels. A. Transverse ultrasonography scan shows normal thyroid gland. B. Scintigraphy scan obtained on same day shows no visible thyroid activity. C. Follow-up scintigraphy at 1 year shows normal thyroid uptake. TSH and free T4 levels were normal. Patient discontinued levothyroxine treatment.

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  Fig. 5 Hemiagenesis in 17-year-old male incidentally detected during pneumothorax evaluation. Transverse ultrasonography revealed no left thyroid gland. Thyroid function was normal.

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  Fig. 6 Dyshormonogenesis in 15-day-old female. A. Transverse ultrasonography scan shows enlarged thyroid gland. B. Tc-99m scintigraphy shows enlarged thyroid gland with increased uptake (20%; normal range, 2-4%). Thyroid stimulating hormone level at time of initial study was > 60 µU/mL, and free thyroxine level was 0.12 ng/dL (normal range, 0.89-1.7 ng/dL).

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  Fig. 7 Thyroglossal duct cyst in 8-year-old girl presenting with palpable mass in anterior neck. Longitudinal (A) and sagittal (B) ultrasonography revealed well-defined cystic lesion (long arrows) below hyoid bone (arrowheads).

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  Fig. 8 Longitudinal scan shows well defined oval isoechoic nodule with inner cystic changes in 18-year-old female. Nodular hyperplasia was confirmed by hemithyroidectomy.

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  Fig. 9 Longitudinal scan shows colloid cyst with comet tail artifact (arrow) in 18-year-old female who underwent neck ultrasonography to evaluate cervical lymphadenopathy.

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  Fig. 10 Intrathyroid thymus in 5-month-old boy who underwent ultrasonography (US) for cervical lymphadenopathy. A. Transverse US scan shows hypoechoic nodular lesion with inner echogenic strands and dots, similar to normal thymus in mediastinum (arrows) (B).

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  Fig. 11 13-year-old female presenting with palpable mass. Transverse ultrasonography scan shows isoechoic oval solid nodule (arrows). Follicular adenoma was confirmed by hemithyroidectomy.

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  Fig. 12 Papillary thyroid cancer presenting with hyperthyroidism in 12-year-old female. Longitudinal ultrasonography scan (A) shows oval hyperechoic nodule with numerous microcalcifications (arrows) and multiple metastatic lymphadenopathy in left thyroid at levels II-IV (B). Microcalcifications and cystic changes are seen. C. Tc-99m scintigraphy shows increased uptake (thyroid uptake 7.2%; normal range, 2-4%), diffuse enlargement of both thyroid gland lobes, and increased uptake in thyroid nodule (short arrows) and in left lateral neck due to metastasis to lymph nodes (long arrows). Surgery confirmed papillary thyroid cancer with metastatic lymphadenopathy and underlying lymphocytic thyroiditis.

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  Fig. 13 Grave's disease in 17-year-old female. A. Transverse ultrasonography scan shows marked enlargement of thyroid gland and inhomogeneous decrease in echogenicity. B. Color Doppler image shows 'thyroid inferno' pattern of hypervascularity.

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  Fig. 14 Suppurative thyroiditis in 10-year-old boy who presented with palpable mass with erythema and tenderness in left side of neck for 3 days. A. Transverse ultrasonography scan shows ill-defined, heterogeneous, hypoechoic lesion (arrows) in left lobe of thyroid gland. B. Contrast computed tomography scan shows ill-defined low-density lesion (arrows) in left lobe with surrounding inflammation. C. Esophagogram shows pyriform sinus fistula (arrow) that was cauterized with 5% trichloroacetic acid.

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