Endocrinologists embrace cutting-edge imaging to transform diagnostics and patient outcomes
Seeing Beyond the Surface
Thyroid ultrasound has revolutionized the field by
offering:
·
High-resolution
imaging to detect nodules,
goiters, and diffuse changes.
·
Real-time
blood flow analysis with
Doppler imaging to assess hyperfunction or neoplastic activity.
·
Guidance
for precise fine-needle aspiration biopsies (FNAB) of suspicious lesions.
·
Post-treatment
surveillance in thyroid
cancer patients, ensuring any recurrence is caught early.
Dr. Mazza shares how imaging enhances her
clinical acumen. “When I use ultrasound in my practice, I’m not just gathering
data. I’m piecing together a story about what’s happening inside my patient’s
thyroid. It’s almost like having a live conversation with the gland itself.”
.
Quick Facts: Thyroid Ultrasound at a Glance
📊 Thyroid disorders affect over 200 million people globally, with nodules found in up to 68% of adults on ultrasound. 🩺 Thyroid cancer is the
most rapidly increasing cancer diagnosis in the 🔬 Office-based ultrasound
use by endocrinologists has doubled in the past decade, with professional
societies offering certification programs. 💡 Advanced features like 3D Doppler and elastography remain underutilized in most practices, despite evidence of their diagnostic value. 🌐 Ultrasound’s accessibility makes it ideal for worldwide application in thyroid care, particularly in low-resource settings. |
Advanced Tools for Advanced Care
3D Doppler: Mapping Vascular Clues
Elastography: The Stiffness Factor
Elastography measures tissue stiffness, a valuable
marker since malignant nodules tend to be firmer than benign ones. Although
still gaining traction, advocates see it as a key tool to reduce unnecessary
biopsies.
“We’re at the
threshold of a paradigm shift,” Dr. Mazza observes. “With elastography, we
could soon make more informed, non-invasive decisions about which nodules need
intervention and which can simply be monitored. That’s empowering for both
physicians and patients.”
Part 2: Approach, Training, and Application of Ultrasound in
Thyroid Imaging
High-resolution ultrasound (
Probe Selection and Technical Parameters
Thyroid US is performed using a high-frequency (7.5–15 MHz) linear array transducer,
which provides the axial and lateral resolution necessary for detailed
evaluation of glandular echotexture and lesion characteristics.[1,2]
Lower-frequency curvilinear probes (2–5 MHz), typical for abdominal or deep
vascular imaging, are inappropriate for thyroid applications due to reduced
resolution at shallow depths.
The imaging depth should be optimized to approximately 3–4 cm, sufficient to visualize the thyroid lobes, isthmus, and adjacent cervical lymph nodes. Focal zones should be set at the level of the thyroid to enhance lateral resolution. Gain settings must be carefully adjusted to avoid over- or underestimation of lesion echogenicity.[3]
.
Patient Positioning and Scanning Technique
.
Scanning begins with transverse
sweeps across the thyroid from the superior to inferior poles,
followed by longitudinal sweeps
along each lobe. The isthmus is assessed in both planes. Color Doppler and
Power Doppler modes are used to evaluate vascularity, which aids in
differentiating inflammatory conditions (e.g., thyroiditis) from neoplastic
processes.[4,5]
.
Advanced applications, including 3D Doppler and elastography, are
introduced in specialized training modules. Elastography measures tissue
stiffness, offering potential utility in malignancy risk stratification, though
its adoption in routine endocrinology remains limited.[6]
.
Thyroid vs. Carotid Ultrasound: A Comparative
Perspective
While both thyroid and carotid
Training Considerations for Endocrinologists
Endocrinologists integrating US into practice
require competency-based training programs covering:
·
Neck anatomy
and sonographic landmarks.
·
Systematic
scanning protocols for thyroid and cervical lymph nodes.
·
TI-RADS
interpretation and fine-needle aspiration (FNA) guidance.
·
Technical
troubleshooting (e.g., scanning in patients with large body habitus or post-surgical
changes).
Certification
programs such as those offered by the
Parathyroid Imaging: Expanding the Role of Ultrasound Beyond the Thyroid By: Dr. Angela Mazza .jpg) Ultrasound has long been established as a critical tool in thyroid evaluation, but its utility extends naturally to the parathyroid glands. These four small, oval-shaped endocrine glands, located posterior to the thyroid lobes, are responsible for regulating calcium homeostasis via parathyroid hormone (PTH) secretion. Pathologies such as parathyroid adenomas, hyperplasia, and rarely carcinoma can disrupt this balance, leading to hyperparathyroidism—a condition with systemic effects including osteoporosis, nephrolithiasis, and neuropsychiatric symptoms. Why Ultrasound for Parathyroid Assessment? High-resolution ultrasound offers a non-invasive, real-time imaging modality that can localize abnormal parathyroid glands preoperatively and assist in the evaluation of neck masses suspected to involve parathyroid tissue. It is particularly useful in patients with primary hyperparathyroidism, where accurate localization of an adenoma can guide minimally invasive parathyroidectomy. Unlike nuclear medicine techniques such as sestamibi scans, ultrasound does not involve ionizing radiation and can provide additional anatomical detail about adjacent structures, including the thyroid gland and cervical lymph nodes. This dual assessment is crucial, as concomitant thyroid nodules are often present in patients being evaluated for parathyroid disease. Technical Considerations in Parathyroid Ultrasound Parathyroid lesions typically appear as hypoechoic, oval-shaped nodules posterior or inferior to the thyroid lobes. Using a high-frequency linear array transducer (7.5–15 MHz) is essential for sufficient resolution. Color Doppler imaging may reveal a characteristic feeding vessel (“polar artery”) entering the adenoma, aiding differentiation from lymph nodes or thyroid nodules. Scanning technique requires careful, systematic evaluation of the thyroid bed, tracheoesophageal groove, and inferior poles of the thyroid lobes, as ectopic parathyroid tissue can be located anywhere along the embryologic migration path—from the carotid sheath to the mediastinum. Clinical Impact and Training Implications Preoperative localization of parathyroid adenomas with ultrasound has been shown to significantly reduce operative time and morbidity. When combined with other imaging modalities, it increases sensitivity for detecting multiglandular disease. For endocrinologists, acquiring proficiency in parathyroid ultrasound complements thyroid imaging skills and allows for a more comprehensive approach to neck pathology. This expanded capability underscores the need for advanced training programs covering parathyroid sonographic anatomy, lesion recognition, and pitfalls such as distinguishing parathyroid lesions from reactive lymphadenopathy or prominent vascular structures. “Adding parathyroid imaging to an endocrinologist’s ultrasound skillset elevates their ability to deliver precise, patient-centered care,” says Dr. Angela Mazza. “It’s about understanding the full endocrine landscape of the neck, not just the thyroid.” |
A Technical Perspective: Dr. Robert Bard on Ultrasound Education
As pioneer in advanced ultrasound imaging and
integrative diagnostics, Dr. Robert Bard underscores the importance of
empowering endocrinologists with cutting-edge imaging skills. “Ultrasound is an
incredibly dynamic modality—it’s portable, safe, and allows for instant
interpretation,” Dr. Bard explains. “But to truly unlock its potential, we need
to go beyond the basics.”
.
Dr. Bard advocates for expanding endocrinology
ultrasound training to include:
·
3D and
4D Doppler for vascular analysis
·
Elastography
to assess tissue elasticity in real time
·
Contrast-enhanced
ultrasound to visualize
microvascular changes
·
Integration
with AI tools for more
consistent image interpretation
“In my
experience, subtle microvascular changes often precede structural ones.
Endocrinologists trained to see these patterns can intervene earlier,
potentially preventing disease progression,” he says. Dr. Bard also emphasizes
interdisciplinary collaboration. “Radiologists, endocrinologists, and
technologists need to work together to build standardized protocols that
optimize ultrasound’s diagnostic power in thyroidology.”
.
The Patient Advantage: Immediate Insight and
Empowerment
For patients, the shift to in-office ultrasound
offers significant benefits:
✅
Instant
results reduce anxiety and expedite care plans.
✅ Dynamic imaging allows them to
watch and understand findings in real time.
✅ Fewer referrals and delays, which
means more efficient care.
Dr. Mazza
describes the profound impact this has on her consultations. “When patients see
their thyroid on the screen, and I can point out what’s happening right then
and there, it changes the conversation. They’re no longer passive recipients of
care—they’re engaged, informed partners in their health journey.”
Looking Forward: A Call for Broader Adoption
“Technology is
only as powerful as the hands that use it,” Dr. Bard reminds. “We need to give
endocrinologists the tools and the confidence to make ultrasound a cornerstone
of their diagnostic process.”
Dr. Mazza
echoes the sentiment: “The future of thyroid care lies in integrating advanced
imaging seamlessly into clinical practice. It’s time we give every patient
access to that level of precision.”
Conclusion: A Vision for the Future
As thyroid disorders continue to rise globally,
ultrasound stands as a beacon of precision and accessibility. With advocates
like Dr. Mazza leading the way and experts like Dr. Bard advancing the science,
this technology is poised to transform endocrinology—bringing clarity,
confidence, and connection to every patient encounter.
References
1.
Moon WJ, Jung SL, Lee JH, et al. Benign
and malignant thyroid nodules:
2.
Gharib H, Papini E, Paschke R, et al. American
Association of Clinical Endocrinologists, Associazione Medici Endocrinologi,
and European Thyroid Association Medical Guidelines for Clinical Practice for
the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16
Suppl 1:1–43. doi:10.4158/EP.16.S1.1
3.
Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in
Ultrasound consensus conference statement. Radiology.
2005;237(3):794–800. doi:10.1148/radiol.2373050220
4.
Remonti LR, Kramer
CK, Leitão CB, Pinto LC, Gross JL. Thyroid ultrasound features and risk of
carcinoma: a systematic review and meta-analysis of observational studies. Thyroid.
2015;25(5):538–550. doi:10.1089/thy.2014.0353
5.
Reading CC,
Charboneau JW, Hay ID, Sebo TJ. Sonography of thyroid cancer. Radiol Clin
North Am. 2000;38(5):1139–1150. doi:10.1016/S0033-8389(05)70226-1
6.
Russ G, Bonnema
SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association
guidelines for ultrasound malignancy risk stratification of thyroid nodules in
adults: the EU-TIRADS. Eur Thyroid J. 2017;6(5):225–237.
doi:10.1159/000478927
7.
Grant EG, Benson
CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US
diagnosis—Society of Radiologists in Ultrasound consensus conference. Radiology.
2003;229(2):340–346. doi:10.1148/radiol.2292030516
8.
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