THYROID ULTRASOUND - 03/09/11
Riassunto |
The initial evaluation of any person suspected of having thyroid disease comprises a clinical history, physical examination, and a variable number of laboratory investigations. There is wide observer variation in the assessment of clinical findings in such patients, particularly in relation to palpation of the thyroid gland49; therefore, it is not surprising that imaging of the thyroid is often performed. Generally, such imaging cannot distinguish between benign and malignant lesions, and its clinical value is thought to be limited.42, 65 Recent surveys of members of the European Thyroid Association (ETA) and the American Thyroid Association (ATA) have demonstrated profound differences in the perceived utility of diagnostic imaging in patients with thyroid disorders. Eighty-eight percent of ETA members responded that they would use imaging in an index case of a euthyroid patient with a solitary thyroid nodule and absence of clinical suspicion of malignancy,11 whereas only 34% of ATA members would use imaging in that situation.12 Whether this discrepancy was related to cost, availability, tradition, or other factors was not disclosed by these studies.
Evaluation of the thyroid gland can be performed using several imaging techniques. Modalities include plain radiography, radionuclide imaging, ultrasonography, CT, and MR imaging. Each technique has advantages and limitations, and it is generally agreed that there is no absolute clinical indication for performing any of these studies in the majority of patients.42, 46, 53, 62, 83, 91 The major limitation of the techniques, in addition to expense and availability, is their lack of specificity for tissue diagnosis. Table 1 lists key characteristics of ultrasonography.
Several recent reviews have focused on the use of thyroid ultrasonography.46, 53, 62, 83, 91 These studies support the view that high-resolution ultrasonography is generally the first choice for evaluation of thyroid size and morphology. Initially used by a few enthusiasts from different medical specialties, ultrasonography has gained widespread use in clinical thyroidology. Although ultrasonography of the thyroid is traditionally performed by diagnostic radiologists and clinical physiologists, the tendency to involve as few physicians as possible in the care of the patients has encouraged thyroidologists to learn and master this technology. In numerous institutions, including the author's, ultrasonography is used as a first-line investigation in many patients with possible thyroid disease.42 This use has broadened the clinical applications of ultrasonography of the thyroid.
This article clarifies the role of ultrasonography in clinical thyroidology by pointing to areas where the technology can aid in clinical decision making.
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| Address reprint requests to Laszlo Hegedüs, MD, Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark, e-mail: laszlo.hegedus@ouh.fyns-amt.dk Work for this article was supported by the Agnes and Knut Mørk Foundation and Den A.P. Møllerske Støttefond (The A.P. Møller Support Foundation). |
Vol 30 - N° 2
P. 339-360 - giugno 2001 Ritorno al numero
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- FINE-NEEDLE ASPIRATION BIOPSY OF THE THYROID
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