Imaging

Toxic Nodular Goiter

Preliminary Diagnosis: Toxic Nodular Goiter

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound of the thyroid gland.

II. Describe the advantages and disadvantages of this technique for diagnosing toxic nodular goiter.

Advantages

  • Highly portable imaging modality.

  • Does not expose patients to ionizing radiation.

  • May help guide percutaneous biopsy and FNA.

  • Able to evaluate the vascularity of any suspicious lesions of the thyroid gland.

Disadvantages

  • Limited in evaluating and characterizing any surrounding soft tissue.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • Nuclear medicine thyroid imaging.

  • CT imaging with IV contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing toxic nodular goiter.

Nuclear medicine thyroid imaging

Advantages

  • Able to detail hot and cold nodules with great specificity.

  • Moderately sensitive in detecting thyroid abnormalities.

Disadvantages

  • Less adept in guiding percutaneous intervention.

  • Limited in detailing and evaluating the surrounding soft tissues, osseous structures, and vasculature.

  • May be subject to image artifact.

CT imaging with IV contrast

Advantages

  • Moderately sensitive and specific in detailing and detecting toxic nodular goiter.

  • May help guide treatment, therapy, and biopsy.

  • Highly sensitive and specific in detecting abnormal mineralized thyroid abnormalities.

  • Offers exquisite visualization and detail of the surrounding soft tissues, osseous structures, and vasculature.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Limited in detailing the vascularity of specific thyroid lesions.

VI. What are the contraindications for the alternative imaging techniques?

Nuclear medicine thyroid imaging

  • May be contraindicated in pregnant patients and those who are breast feeding.

CT imaging with IV contrast

  • May be contraindicated in pregnant patients.

  • May be contraindicated in patients with renal failure and contrast allergy.

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