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.