Private Ultrasound for Thyroid Nodules: A Guide to Diagnosis and Treatment

Thyroid nodules are extremely common, detected in around 50% of people by the time they reach 60 years old. The vast majority of these nodules are benign growths that do not require any treatment. However, an estimated 5-15% are malignant, so proper diagnosis is critical. This is where an expert ultrasound by an experienced sonographer can provide invaluable information.

At my private ultrasound clinic Sonoworld in London, we frequently see patients referred for investigation of thyroid nodules found on physical exam or other imaging studies. An ultrasound appointment allows us to further assess the features of the nodules and determine if they are likely benign or if biopsy is warranted. Our detailed ultrasound reports then help guide the best course of management.

When Private Ultrasound is Recommended

There are several symptoms and clinical factors that may prompt referral for a thyroid ultrasound:

• Palpable nodule found on neck exam, especially if >1cm
• History of thyroid cancer
• Family history of thyroid cancer
• Radiation exposure as a child or young adult
• Rapid nodule growth
• Hoarseness, swallowing difficulties or neck pain
• Very large multi-nodular goiter

An experienced sonographer like those at my clinic can provide peace of mind if the nodules appear benign. Conversely, we may recommend biopsy or surgery if the nodules exhibit more concerning traits.

The Ultrasound Appointment

The thyroid ultrasound itself is quick, taking just 10-15 minutes. No radiation is involved like in CT or nuclear scans. You simply lie back with your neck exposed while an ultrasound probe is moved over the thyroid gland area.

The sonographer may have you turn your head to better visualize the regions and measure any nodules in multiple planes. Doppler ultrasound can also assess blood flow in and around the nodules.

Having an expert sonographer perform the ultrasound is key - they will systematically evaluate the thyroid and recognize subtle characteristics that suggest if nodules require further testing. Our team has extensive experience performing targeted thyroid ultrasound to provide the most accurate impressions.

Key Diagnostic Features on Ultrasound

There are a number of ultrasound characteristics we look for when determining if thyroid nodules are likely benign or suspicious:

Benign features include:

• Purely cystic nodules - these are fluid-filled and very unlikely to be cancerous
• Spongiform appearance - clusters of microcysts that create a "sponge-like" look
• No increased blood flow on Doppler imaging

Concerning features include:

• Solid hypoechoic nodules - appear darker than normal thyroid tissue
• Irregular margins and microcalcifications
• Taller-than-wide "shape" on 2D imaging
• Increased Doppler flow in or around the nodule

Our ultrasound reports will describe the number of nodules present along with a detailed evaluation of their size, appearance, and other characteristics using standard terminology. We indicate an overall impression of whether biopsy is recommended based on the ultrasound findings.

Biopsy Considerations

If the ultrasound reveals nodules with several suspicious traits, I will typically recommend biopsy to establish a definitive diagnosis. The main biopsy options include:

• Fine needle aspiration (FNA) biopsy - a thin needle extracts cells from the nodule for microscopic analysis. Low risk procedure done right in our clinic.
• Core needle biopsy - uses a larger hollow needle to obtain a small tissue sample from the nodule. Also performed onsite if needed.

The pathology results allow us to confirm if cancer is present and determine the best course of treatment. Biopsies carry a small risk of bleeding and infection, but provide vital diagnostic information in cases where nodules appear potentially malignant.

Treatment Options

Many thyroid nodules, especially cystic or purely benign ones, simply require periodic monitoring with ultrasound. We can surveil nodule size over time and intervene if any demonstrate concerning growth.

If cancer is confirmed on biopsy, the typical treatment is surgical thyroidectomy. However, for some small low risk thyroid cancers, close ultrasound surveillance may be reasonable to avoid surgery.

There are also some promising new non-surgical treatments on the horizon, like laser thermal ablation. This uses a laser inserted into the nodule to destroy thyroid cancer cells via heat, and may soon provide a minimally invasive option for select patients.

Conclusion

Thyroid nodules are extremely common, but only a small percentage are malignant. Targeted thyroid ultrasound by an experienced sonographer provides important diagnostic information to determine which nodules require biopsy or surgery versus conservative monitoring.

At Sonoworld, our experienced team provides compassionate patient-centered care combined with expert ultrasound evaluation. We aim to alleviate anxiety for those referred with thyroid nodules and guide appropriate evidence-based management.

If you have any concerning symptoms or thyroid nodules requiring further evaluation, we encourage you to schedule a consultation. An expert ultrasound can provide vital peace of mind or early detection to ensure you receive the best possible care.