thyroid throat discomfort

[Lena Truong]

Hello Steve,
Can you have a look at these images and give us your opinion please? The patient reports focal tenderness in the right anterior neck when he raises his voice. When we put the probe at the ROI, and compared to the other side, we noticed an asymmetry between the left and right sides adjacent to the tracheal area at the level of the thyroid. Do you have any thoughts on what this could be?

We also noticed an incidental echogenic round structure inferior to the left lobe of the thyroid which we often see in other patients as well. Do you know what this is?

Kind regards,
Lena

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[Stephen Bird]

Hi lena,

At this level (just as you are getting to the upper part of the thyroid) you start to come into the cricoid cartilage.
Below this level you just see the trachea, but at the level you are at you are just coming into cricoid cartilage. The cricoid cartilage is very variable so you will often see asymmetry and I think that is what you have here. It may also have calcification within it and also cystic areas commonly, all of which are of no significance as far as I know.

So I think you are seeing normal anatomy.

If you continue to scan further up the neck towards the chin you will see the larger thyroid cartilage appear and then the next structure you bump into is the hyoid bone which marks the entry to level 1 for neck nodes.

As for the echogenic area below the lower pole of the thyroid, do you have an image for me?

The thing that comes to mind is persistent thymus tissue which has an echogenic ground glass appearance and is also a normal variant in adults, and more commonly seen in children,

Steve

[Lena Truong]

Hello,

I’m sorry I didn’t realise the second picture wasn’t attached. This is a transverse image of the echogenic area after volume scanning directly inferior to the left lobe of the thyroid.

Kind regards,
Lena

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[Stephen Bird]

Hi Lena,

I am still not particularly worried about anything here,

The echogenic area could still be a bit of thymus,

Or some fat,

Another thought: did you think on your first image that the right lobe of thyroid is less echogenic than the left? or was it just projectional?

If you have a thyroiditis in the earlier stages it may affect one lobe a lot more than the other and it is a patchy process. In cases like this normal thyroid tissue that is yet to be affected looks echogenic against the background of the thyroiditis which makes the thyroid tissue look hypo echoic.

Steve

If you have some more images I would gladly take a look.

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