First ultrasound examination after years of a neglected goitre.
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Extremely enlarged multinodular thyroid gland. Isthmus is around 12 mm in the biggest diameter. The biggest node is in the left lobe and measure around 65 x 38 x 50 mm (CC x AP x LL), heterogeneous, with areas of cystic and colloid degeneration, with calcifications up to 3 mm, with increased peri and intranodal vascularity.
Centrally in the submandibular region there is an anechoic 9 mm lesion and the differential diagnosis includes thyroglossal duct cyst or cystic lymph node (small possibility).
The patient was diagnosed with multinodular goitre years ago but left it untreated.
Now she was referred because of difficulties breathing and swallowing, arrhythmia and dilatated neck veins. FT4 is three times over the upper normal limit.
This patient was sent to the surgeon for the biopsy, further evaluation, and treatment per TI-RADS recommendations.