Ultrasound Characteristics of Worrisome vs. Benign Thyroid Nodules

Ultrasound is increasingly important in the evaluation of thyroid nodules. It is also critical in the surveillance of patients with prior history of thyroid cancer. High resolution ultrasound in the hands of experienced clinicians can be very helpful in estimating malignant potential of thyroid nodules and neck lymph nodes.

It is important to emphasize that ultrasound cannot be used to diagnose malignant thyroid nodules. Pathologic evaluation of the nodule is required to establish a diagnosis of thyroid carcinoma. In many cases, fine needle aspiration (FNA) biopsy of the thyroid will provide enough tissue to enable us to make the diagnosis of a malignant nodule. At the very least, FNA biopsy is usually able to identify worrisome nodules that should be surgically removed.

However, certain ultrasound characteristics of thyroid nodules are very helpful in the identification of higher risk nodules.

Sonographic Finding	Worrisome Nodule	Benign Nodule
Calcifications	Microcalcifications	Coarse Calcifications; Egg Shell
Margins	Irregular	Smooth
Halo	Absent	Present
Echotexture	Hypoechoic	Hyperechoic
Vascularity	Increased Intranodular Flow	Low
Shape	Depth > Width	—
Cyst	Thick Walled	Thin Walled, Simple Cyst
Lymph Nodes	Present	Absent

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