black spot on ultrasound?
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| Wed, 01-19-2005 - 5:21pm |
Hi, again - coming out of lurkdom to ask another question - my sister, who is 35, was told at her recent physical that she has an enlarged thyroid. The doctor said she was surprised that my sister hadn't noticed it, but I guess she had noticed that her turtelnecks weren 't comfortable, and neither was swallowing (she just didn't think "thyroid.") So today she went for an unltrasound on her thyroid. She said, "It was very clear that on the enlarged side there was a large black elliptical shape... and on the other side, there was nothing." She doesn't expect to hear from them formally about the results until Friday. Does anyone have an idea what this means, or just what the possibilities are? I'm hypothyroid, on levothyroxine, but never had to do an ultrasound or anything. I would really appreciate whatever you could share with me.
Mary

Hi Mary - I haven't been able to find an easy answer to this one. Here are two sites that provide some good, basic information and the second one also goes into great detail but it is too complex for me to understand!!
It's possible that what the scan showed was the actual nodule and nothing more than that. From what I *did* understand in all this, the ultrasound can show the presence of the nodule and the size, but not much more. It would take a thyroid scan or a fine needle aspiration biopsy to know more about what the nodule is - Keep in mind that 85% of all nodules, if that's even what your sister has, are benign. I hope this helps a bit!! Sorry I couldn't find anything more conclusive for you. Let us know how she does! Cathy :)
http://www.endocrineweb.com/noduleus.html
http://www.thyroidmanager.org/FunctionTests/usound-text.htm
IV. SONOGRAPHY IN THE PATIENT WITH AN ENLARGED THYROID GLAND (GOITER
Thyroid sonography probably is not cost effective in evaluating the average patient with thyroid enlargement. Since thyroid goiters are common and rarely associated with malignancy, there is little useful purpose to sonographic documentation of the size, shape, or uniformity of a goiter. However, sonography may be used in a goiter to identify for biopsy nonpalpable thyroid nodules that are over 1 cm. in diameter, the value of which is under current scrutiny. At this time, the data seems persuasive that the incidence of cancer in a particular nodule in a goiter is independent of the number of sonographically identified nodules, in distinction to prior belief. Therefore, this practice seems worthwhile. In addition, sonography will effectively answer a specific clinical question about a patient with a goiter.
At times, it will be useful to know the ultrasonic appearance of a dominant nodule in a goiter, a tender spot, a region of focal hardness because it might give a clue about pathology. (FIGURE 2) For example, sonography can identify one region in a goiter whose echo pattern is distinct from the rest of the goiter suggesting a second type of pathology, especially if the region is surrounded by a sonoleucent rim. Among the lesions that have been demonstrated in goiters using sonography are neoplasms and lymphoma. Other uses of sonography in goitrous patients include: differentiation of thyroid enlargement from adipose tissue or muscle, identifying a large unilateral mass in distinction to an asymmetric goiter, confirming substernal extension, providing the correct interpretation to varying clinical impressions among several examiners, and objectively documenting volume changes in response to suppressive therapy with thyroid hormone, which may be particularly useful when patients change physicians.
An interesting public health use of sonography in underdeveloped countries has been to objectively identify goiter as a screen for iodine deprivation. Furthermore, in the epidemiological setting, with proper ultrasound equipment, assessment of thyroid volume and prevalence of thyroid nodules, but not echogenicity or echographic pattern, are comparable among different observers.
Thanks so much for your response! I thought I'd post that the doctor called my sister, and turns out that dark elliptical spot on the u/s seems to be a fluid-filled cyst. They are planning to do a needle aspiration and biopsy, but they believe it is nothing serious to worry about. I'm really happy and relieved!
Mary