Frequently, calcifications are encountered in the thyroid parenchyma, generally representing areas of degenerative or postinflammatory regression that do not require further evaluation.
The decisive information for further assessment of a hypoechoic nodule is provided by the radionuclide thyroid scan because the functional status of a nodule cannot be deduced from its sonographic features. Scintigraphically functioning nodules ("hot" nodules) primarily correspond to
Vagus nerve (a), fibrous capsule of thyroid (b), isthmus (c), platysma (d), omohyoid muscle (e), skin (1), subcutaneous fat tissue (2), esophagus (34), spine (35), lateral lobes of thyroid (81), common carotid artery (82), internal jugular vein (83), trachea (84), sternocleidomastoid muscle (85), anterior and medial scalenus muscles (88), sternohyoid muscle (89), sternothyroid muscle (90).
areas of adenomatous hyperplasia or true adenomas, whereas non-functioning hypoechoic nodules ("cold" nodules) must arouse suspicion of malignancy and are generally subjected to sonographically-guided needle aspiration biopsy.
Though hyperechoic nodules are less likely to be malignant, they also should be considered for needle aspiration biopsy, unless their true nature can be established by combining the results of laboratory tests, sonography, and scintigraphy.
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