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Age: 37

Sex: Female

Indication: Hyperthyroidism

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Case #25


  • Diffuse enlargement of the thyroid gland with diffuse markedly increased vascularity
  • Mildly heterogeneous thyroid parenchyma without discrete nodule


Graves’ disease

Sample Report

Diffuse enlargement of the thyroid gland with diffuse markedly increased vascularity. In the setting of hyperthyroidism, this appearance is most suggestive of Graves’ disease.

No discrete thyroid nodule.


  • Evaluation of diffuse thyroid diseases can be challenging on ultrasound because imaging findings vary and may overlap between conditions
  • Refer to the table below for a summary of characteristic findings of several diffuse thyroid diseases
  • For these cases, it is very important to know the clinical history since the interpretation of these studies is different depending on acuity of onset, the patient’s thyroid function, and whether or not the gland is painful
  • Note that many of these conditions can produce thyroid nodules and pseudonodules, which can at times be difficult to differentiate from neoplasms. Followup imaging and correlation with nuclear medicine evaluation can be helpful, but ultimately some nodules require fine-needle aspiration to rule out neoplasm


Diffuse Thyroid Diseases

TypePatient demographicsPainfulThyroid functionGrayscale US findingsDoppler findings
Chronic lymphocytic thyroiditis (Hashimoto)
45-65 yrs old
Euthyroid or sometimes hyperthyroid initially
Hypothyroid chronically
Enlarged gland
Heterogeneous and hypoechoic with developing nodules and echogenic fibrous bands
May be hypovascular or mildly hypervascular
Graves’ disease
20-50 yrs old
Enlarged gland
Heterogeneous and hypoechoic
Markedly hypervascular
Subacute granulomatous thyroiditis (de Quervain)
Hyperthyroid → Hypothyroid → Euthyroid
Ill-defined hypoechoic nodules becoming more numerous/diffuse as disease progresses
Often unilateral
Hypovascular (involved areas may be mildly hypervascular during recovery phase)
Acute suppurative thyroiditis
Children, rare
Usually on left associated with anomalous piriform fossa sinus
May be hyperthyroid acutely
Heterogeneously hypoechoic
May develop discrete hypoechoic abscesses
Mildly hypervascular (avascular within abscess)
Subacute lymphocytic thyroiditis
Postpartum subtype
Hyperthyroid → Hypothyroid → Euthyroid
Gland may be diffusely hypoechoic or have ill-defined hypoechoic nodules similar to de Quervain thyroiditis
Usually normal to hypovascular
Fibrous thyroiditis (Riedel)
Associated with IgG4 disease
Firm gland
Normal to mildly enlarged gland
May have hypoechoic mass

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