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Ultrasound Thyroid and Neck

USNo contrastHead & Neck

Indications

Palpable neck mass or thyroid nodule
Abnormal thyroid function / goiter
Follow-up of known nodule
Incidental nodule on cross-sectional imaging
Cervical lymphadenopathy

Patient prep

None
Supine with neck extended; pillow under shoulders

Contrast

None / non-contrast

Technique

High-frequency linear transducer 7-15 MHz
Supine, hyperextended neck; survey both lobes and isthmus in long and transverse
Color Doppler for nodule vascularity and parenchymal flow
Survey central and lateral cervical nodal chains

Series / Sequences

#	Series / Sequence	Plane	Notes
1	Right thyroid lobe	Long axis and transverse	Measure 3 dimensions (length, AP, width)
2	Left thyroid lobe	Long axis and transverse	Measure 3 dimensions
3	Isthmus	Transverse	Measure AP thickness
4	Any nodule	Two planes	Measure 3 dimensions; document composition, echogenicity, shape, margin, echogenic foci (TI-RADS)
5	Nodule Doppler	As needed	Vascularity
6	Cervical lymph nodes	As needed	Suspicious nodes (rounded, loss of hilum, microcalcs, cystic)

Key points

Characterize nodules using ACR TI-RADS (composition, echogenicity, shape, margin, echogenic foci) to determine FNA thresholds
Taller-than-wide shape, irregular/lobulated margins, microcalcifications, and marked hypoechogenicity are suspicious features
Report nodule size in 3 dimensions; document largest/dominant and clinically relevant nodules
Evaluate cervical nodes for metastatic features

References

• AIUM Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination
• ACR TI-RADS White Paper (Tessler et al., J Am Coll Radiol 2017) link
• Radiopaedia: Thyroid ultrasound link

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.