Abnormal ultrasound, as discussed above, including a 1.8 cm TI-RADS 5 right
thyroid nodule. Published guidelines recommend endocrinology consultation and
biopsy. In addition to sampling of the 1.8 cm right posterior mid-upper upper
thyroid nodule, FNA of other portions of the gland containing numerous punctate
echogenic foci, presumed microcalcifications, should also be considered,
particularly in the right lower pole.
The thyroid gland is heterogeneous and demonstrates nodularity of the capsule
contour. The right lobe in particular demonstrates marked parenchymal
heterogeneity and numerous punctate hyperechoic foci throughout the lobe, likely
punctate calcifications. There is a discrete 1.8 cm nodule in the mid to upper
right lobe with suspicious morphologic features, discussed below.
Other small punctate hyperechoic foci are also seen in the isthmus and at the
lower pole of the left lobe, without evidence of discrete isthmus or left lobe
Inferior to the left thyroid lobe, an ovoid fusiform structure with smooth
margins measures 1.9 x 1.5 x 0.8 cm, isoechoic to the left thyroid lobe but not
clearly contiguous with it. This may represent ectopic thyroid tissue.
Individual nodules were selected for measurement based on ACR TI-RADS criteria.
Location: Right posterior mid-upper, partially exophytic
Size : 1.8 x 1.2 x 1.5 cm
Composition: Solid: 2
Echogenicity: Mixed hyperechoic and hypoechoic: 2
Shape: Wider than tall: 0
Margins: Irregular: 2
Echogenic foci: Multiple small punctate echogenic foci: 3
Total points: 9
TI-RADS category: 5. Biopsy is advised.