Benign Conditions of the Thyroid Gland Amy Fan-Yee Juliano , MD , , Mary Beth Cunnane , MD

Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

Infectious and autoimmune diseases account for the majority of benign conditions of the thyroid gland. They are usually diagnosed and followed by clinical examination and laboratory analyses, but when imaged, ultrasonography and computed tomography are the modalities of choice. In particular, fine needle aspiration under ultrasound guidance may be invaluable for diagnostic and therapeutic purposes.

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Figure 1. Acute suppurative thyroiditis. (A) Transverse color-Doppler ultrasonography (US) image of the left upper pole. The parenchyma is hypoechoic and edematous with mild increased vascularity. In the posteromedial aspect is an abscess (arrow). (B) Axial contrast-enhanced computed tomography (CT) demonstrates a diffusely enlarged gland with areas of heterogeneous hypodensity. Note blurring of surrounding fat and edematous appearance of adjacent structures from secondary inflammatory involvement. (C) Axial postcontrast T1-weighted magnetic resonance image shows enhancing inflammatory tissue and an abscess (arrow). (Color version of figure is available online.)

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Figure 2. Acute suppurative thyroiditis related to a pyriform sinus fistula. Contrast-enhanced CT image (A) shows edema and heterogeneously enhancing inflammatory soft tissue in the left postcricoid pharynx. Barium swallow (B) demonstrates a pyriform sinus fistula (arrow).

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Figure 3. Subacute thyroiditis. Noncontrast-enhanced CT image demonstrates a diffusely enlarged thyroid gland with hypodense areas.

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Figure 4. Graves disease. Sagittal gray-scale image (A) of the thyroid gland demonstrates mild inhomogeneity. Sagittal color-Doppler image (B) demonstrates diffusely increased vascularity throughout the thyroid parenchyma, the so-called “thyroid inferno.” (Color version of figure is available online.)

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Figure 5. Hashimoto thyroiditis. Sagittal US image (A) demonstrates a mildly enlarged gland with a few irregular hypoechoic areas with echogenic rims (arrows) seen in the early stage. In the advanced stage (B), the gland is coarse in echotexture, multinodular, and is predominantly hypoechoic.

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Figure 6. Hashimoto thyroiditis and lymphoma. Axial contrast-enhanced CT image demonstrates an enlarged and heterogeneously hypodense thyroid gland. However, the posterior aspect is even more hypodense, and extends as exophytic soft tissue posterior to the trachea (between arrows), inseparable from the esophagus (arrowhead). This area is involved by lymphoma.

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Figure 7. Goiter. Coronal (A) and axial (B) images through the neck demonstrate an enlarged heterogeneously enhancing mass, which is contiguous with the left lobe of the thyroid and extends substernally into the mediastinum (arrows). There is mass effect on the trachea, without compression.

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Figure 8. Intrathyroidal ectopic thymus. Sagittal US image shows a well-defined hypoechoic nodule, which on biopsy proved to be ectopic thymic tissue.

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Address reprint requests to Amy Fan-Yee Juliano, MD, Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114

Copyright © 2012 Elsevier Inc. All rights reserved.