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What Does It Mean If Your Thyroid Is Heterogeneous

What Is Hashimotos Thyroiditis

What is Thyroid Disease? (HealthSketch)

Hashimotos thyroiditis is an autoimmune disorder that damages the thyroid gland. Autoimmunity occurs when immune cells attack healthy tissue instead of protecting it, leading to chronic inflammation.

In Hashimotos thyroiditis, immune cells mistakenly attack the healthy thyroid tissue, causing inflammation of the thyroid. This damage can eventually lead to inadequate thyroid hormone production. Without enough thyroid hormones for your body to function correctly, you develop hypothyroidism.

Hashimotos thyroiditis is the leading cause of hypothyroidism in the United States, affecting roughly 5% of the population.

Enlarged Thyroid Vs Painful Thyroid

It’s important to differentiate between an enlarged thyroid gland and a painful thyroid gland.

This one single symptom is unique to very few conditions and can easily help you figure out a diagnosis.

Your thyroid gland is an organ and is susceptible to inflammation and infection, just like other parts of your body.

This condition occurs very rarely, however, because for the most part your thyroid is protected from the rest of your body.

Infections such as viral and bacterial bugs can result in a condition known as subacute thyroiditis .

This is one of the very few conditions which cause pain in the thyroid gland when touching it.

Subacute thyroiditis can also result in an enlargement of the thyroid gland but it’s almost always associated with pain.

This pain is important because it can easily help differentiate other, more serious, conditions which cause an enlargement of your thyroid gland.

The Diagnosis Meaning And Treatment Of Thyroid Nodules

Thyroid nodules are most commonly found when a doctor examines a patient’s neck, feeling the thyroid gland. Sometimes thyroid nodules are found when a patient gets x-rays or scans of the neck for some other reason. Sometimes it is a screening x-ray or scan for carotid arteries or neck pain that shows nodules in the thyroid. Thyroid nodules that are large, develop in women with thin necks, or are present in the middle portion of the thyroid gland may be visible and discovered as a lump in the neck.

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Other Causes Of Hyperthyroidism

Hyperthyroidism can also result from thyroid nodules. These are lumps that develop inside the thyroid and sometimes begin producing thyroid hormones. Large lumps may create a noticeable goiter. Smaller lumps can be detected with ultrasound. A thyroid uptake and scan can tell if the lump is producing too much thyroid hormone.

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Poorly Differentiated And Anaplastic Carcinoma

Thyroid malignancy

Poorly differentiated carcinomas are characterised by an incomplete tumour capsule with expansive growth . Microscopically, monomorphic carcinoma cells can create a heterogeneous structure along with insular, trabecular, and solid patterns in the majority of cases . In a few cases, the main tumour may be accompanied by satellite nodules. When a well-differentiated carcinoma dedifferentiates, it may macroscopically resemble a colloidal tumour , which is closely surrounded by a solid tumour with necrosis . The probability of dedifferentiation of a well-differentiated carcinoma is low .

Clear contrast between the phenotypic heterogeneity of the tumour centre and tumour border was observed in a study of encapsulated thyroid tumours of follicular cell origin with high-grade features such as a high mitotic rate and tumour necrosis . All 8 of the non-invasive tumours examined showed indolent behaviour despite the presence of focal/extensive tumour necrosis. The authors stressed that surgical removal of these non-invasive tumours with necrosis and high mitotic activity may have interrupted their biology and prevented their progression into high-grade invasive carcinomas.

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What Causes Atrophic Thyroiditis

Atrophic thyroiditis is defined in various ways, but in this article, I consider atrophic thyroiditis as autoimmune-caused severe thyroid gland atrophy necessitating lifelong thyroid hormone replacement.

Atrophic Thyroiditis is a HYPOthyroid form of Graves disease. Jara, et al, 2008, explains that Atrophic Thyroiditis patients usually have a Graves disease genetic profile, which is quite distinct genetically from Hashimotos.

The normal form of Graves HYPERthyroidism is caused by TSH-Receptor *stimulating* antibodies that overstimulate the thyroid gland to produce hormone, even in the absence of TSH.

But Atrophic Thyroiditis is associated with the presence of TSH-Receptor *blocking* antibodies that cause HYPOthyroidism.

The blocking antibody prevents TSH from stimulating TSH receptors in the thyroid gland and other tissues where the receptor is expressed. Therefore, even in patients with extremely high TSH levels over 100 can have no TSH stimulation of their thyroid gland when the antibody is strong enough to block the receptors.

  • As demonstration that the blocking antibody is a Graves disease-associated antibody, according to Fröhlich & Wahl, 2017, Thyroid Autoimmunity, blocking anti-TSH-Receptor antibodies occur in 2575% of Graves Disease patients.

Therefore, current science points to the copresence of both blocking and cleavage TSH receptor antibodies as the likely cause of thyroid gland atrophy .

Most Thyroid Nodules Are Benign But Some Thyroid Nodules Are Thyroid Cancer

A small percentage of thyroid nodules are malignant . You can not tell if a thyroid nodule is malignant due to symptoms or lack of symptoms. Those thyroid nodules that are cancer, tend to be very slow growing. The very rare thyroid nodule that is an aggressive thyroid cancer may present with a large thyroid mass, firm or non-mobile mass or even change in vocal quality. Only in these very rare circumstances, when the thyroid nodule is an aggressive thyroid cancer, is there an urgent need for prompt evaluation and thyroid cancer surgery by the most highly experienced thyroid cancer surgeon. Otherwise, thoughtful evaluation and consultation by an expert thyroid cancer surgeon is required for thyroid nodules. In other words, the vast majority of thyroid nodules can be worked up without a sense of urgency. Don’t make rash, quick decisions–thyroid nodules in almost all cases provide plenty of time to get figured out. So chill if you are here because you just found out you have a thyroid nodule. Read and understand what this means. And realize that in almost all cases, you have time to figure this out! We have created a Thyroid Nodule and Cancer Guide app to help, you can to better understand your thyroid nodule, determine what you “next steps” are, and examine your risk of thyroid cancer.

Watch a video at

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What Are The Signs And Symptoms Related To Thyroid Nodules

Most thyroid nodules do not cause any symptoms. Some thyroid nodules show up as a painless lump in the neck that you can feel or see. Thyroid nodules usually move up and down with swallowing.

When thyroid nodules become large they may cause symptoms by pressing on the airway or esophagus. These are also called compressive symptoms. Compressive symptoms include:

  • discomfort with swallowing

At the UCLA Endocrine Center in Los Angeles, multiple layers of evaluation are designed to help you avoid invasive tests and surgery whenever possible. Consultation, ultrasound, and FNA can all be performed in a single visit.

Initial evaluation of a newly discovered thyroid nodule begins with:

  • Assessment by an endocrinologist or endocrine surgeon
  • Thyroid function tests
  • Neck ultrasound performed by your doctor

An ultrasound is a highly accurate tool to visualize your nodule. There is no associated radiation with ultrasounds and it is non-invasive. Ultrasounds are cost-effective as most patients really don’t need any other imaging because the ultrasounds are the best way to look at the thyroid, all present nodules, and the lymph nodes in the neck.

Our cytopathologists evaluate over 1000 samples per year, so we are confident in the accuracy of our biopsies. When biopsy does not give a clear answer, we automatically use molecular profiling to refine the diagnosis.

Thyroid Volume Distribution In Hypothyroid Patients Vs Controls

Three Types of Thyroid Diseases

A right-skewed distribution of thyroid volume was observed in both patients and controls, which is in accordance with other studies reporting this in patients with autoimmune thyroiditis, independent of biochemical status . Patients had a statistically lower thyroid volume than controls but with a large overlap. The dispersion of thyroid volumes was considerably larger in hypothyroid patients than in controls, illustrating that indeed some patients tend to have an increase and other a decrease in thyroid volume. On the other hand, the distribution of thyroid volumes was Gaussian with no sign of distinct subgroups. This finding was somewhat unexpected because primary autoimmune hypothyroidism is often divided into two clinical subtypes : Ords hypothyroidism with atrophic thyroid gland, and Hashimotos hypothyroidism with glandular hypertrophy and/or goiter. The volume distribution in patients diagnosed with autoimmune hypothyroidism was the same in both sexes, and Q-Q plots illustrated a pearls-on-a-string pattern with no sign of a bimodal distribution. Our findings indicated that patients with a small or large thyroid gland represent only extremes of a continuous Gaussian distribution.

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Imaging And Evaluating Your Thyroid

One of the best ways to look at your thyroid gland is by imaging it or looking at it via ultrasound .

Ultrasound is a nearly painless procedure which allows radiologists to look at the size, shape, texture and other characteristics of your thyroid gland.

Because the thyroid gland is near to the surface of your skin it can easily be assessed with this type of imaging.

The good news about ultrasound testing is that it is NOT associated with radiation exposure and is therefore considered to be very safe .

Doctors are often taught that the only way to hurt someone with an ultrasound is by throwing the machine at them.

Ultrasound is very important if you have an enlarged thyroid because it can further help to diagnose what exactly you are dealing with.

For instance:

If you have a single large thyroid nodule, ultrasound can pick up that nodule and give information regarding the size, shape, and consistency of the nodule.

This information can help to determine if the nodule is benign ) or potentially cancerous and also help determine if you need a biopsy.

Other conditions which cause thyroid enlargement may be consistent and make your thyroid look “irregularly inconsistent” throughout the entire gland.

Conditions which cause this type of pattern tend to result in inflammation of the entire gland or may be caused by nutrient deficiencies such as iodine deficiency.

In addition to ultrasound testing, there are other ways to check your thyroid gland such as uptake tests or CT scans .

What Are The Treatments For Thyroid Goiter

  • Observation
  • If the ultrasound with or without biopsy suggests that the patient has benign small thyroid goiter and there are little to no symptoms, the doctor may suggest simply watching the patient and the goiter. The duration of observation is however somewhat arbitrary. Observation usually implies repeating thyroid blood tests, ultrasound, and physical examination in approximately one year. If the thyroid goiter should increase in size or establish symptoms, another intervention may be indicated. Small thyroid goiters that dont change over a period of years may never require any treatment whatsoever.
  • Thyroid Hormone Therapy
  • If you have hypothyroidism , your doctor will prescribe you thyroid hormone in the form of a pill or capsule. There are different types of thyroid hormone pills that doctors may prescribe to deal with low hormone levels. In theory, prescribing thyroid hormone can lower the thyroid stimulating hormone production of the pituitary gland and thus decrease the stimulation to growth of thyroid tissue. In many instances, when patients have been hypothyroid, this may result in a decrease in the size of the thyroid goiter.
  • Radioactive iodine therapy
  • Continued observation of your thyroid goiter
  • Radioactive Iodine Therapy
  • Used in circumstances where the thyroid goiter is associated with excess thyroid hormone production
  • Taken orally
  • RAI treatment frequently results in reduced size of the goiter
  • Surgery
  • The thyroid goiter is large
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    Study Design And Inclusion Criteria

    This study was a retrospective study approved by the Institutional Review Board, with waiver of informed consent. We retrospectively included 2,932 patients who underwent thyroid ultrasonography from January 2017 to August 2019. 1,666 patients had HT and 1,266 patients had normal thyroid parenchyma. Among all patients, 80% were included as the training set and the rest 20% as the test set so that images in the training set do not appear in the test set.

    All selected patients meet the following criteria for image quality control: each nodule should have at least one image from at least two orthogonal planes, the position and size match the ultrasound report and pathological report if pathological result is needed.

    The requirement for pathological results depended on the grading of nodules. All nodules were graded using K-TIRADS in this study. Nodules with TIRADS 4A or above need to have definitive pathological results to be included in this study, while nodules graded TIRADS 2 or 3 were recognized as benign nodules and did not necessarily need pathological results.

    The inclusion criteria for HT were as follows: thyroid parenchyma showed heterogeneous echogenicity under ultrasound serum TPOAb > 5.61 IU/ml and/or TGAb > 4.11 IU/ml TRAb within normal range.

    What Does It Mean If Your Thyroid Is Heterogeneous

    Does your Thyroid Ultrasound look like these examples ...

    or it could indicate one of a number of inflammatory/infiltrative processes i.e, A 3 mm cyst is present at the superior pole left lobe, isoechoic nodule, There is a 15mm circumscribed nodule which appears to exhibit a plane of seperation from the lower pole ofIt means your thyroid is not uniform in its composition, and there are many contributing factors., Doppler evaluation is within normal limits, Hashimotos thyroiditis is the most common cause of hypothyroidism in the US.

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    What Does It Mean When Your Thyroid Gland Is Heterogeneous

    A heterogeneous thyroid gland means that the gland is abnormal, according to the Research Institute of Radiological Science. A normal, or homogeneous, thyroid has uniform tissue throughout. An abnormal thyroid gland often presents with nodules, which may or may not be cancerous.

    Most thyroid nodules are benign, according to both the Research Institute of Radiological Science and Mayo Clinic. Some are even silent. However, they still indicate possible thyroid disease and need to be investigated by a medical professional. Even a cancerous thyroid has a good prognosis if its detected early.

    If thyroid nodules cause symptoms, they might present as lumps that are felt or seen in the neck. Some are large enough to interfere with swallowing or breathing, states Mayo Clinic. Some stimulate the thyroid to produce excess thyroid hormones, which leads to hyperthyroidism symptoms.

    These symptoms include weight loss, even though the patient isnt trying to lose weight, or an increased appetite, tachycardia, trembling, weakness, nervousness and an inability to tolerate heat, claims Mayo Clinic. Complications of hyperthyroidism can be osteoporosis, or weakened bones, and a thyrotoxic crisis. This is a potentially fatal development that requires immediate medical attention.

    A heterogeneous thyroid can be caused by an iodine deficiency or goiter, cysts, inflammation, overgrowth of thyroid tissue and cancer, also according to Mayo Clinic.

    Signs Of End Stage Hashimotos

    The good news is that it takes a long time for end stage Hashimotos to really set in.

    And I mean a long time.

    We are talking probably somewhere around the order of 20-30 years .

    In order to reach this late stage of this disease you really need to have not treated or attempted to treat/manage your Hashimotos for several decades.

    So, if you are reading this there is a good chance that there is still time for you to do something about your condition to try and prevent this issue from occurring!

    But there is also bad news.

    The bad news is that MOST people with hypothyroidism have Hashimotos and a great many people have no idea that they do.

    Its not common for doctors to test thyroid antibodies routinely so many people with hypothyroidism have Hashimotos without realizing it.

    And Ive lost count of the number of patients that Ive treated who have no idea why they take thyroid medication but who have been on it for 20+ years.

    These patients are often surprised when I check their thyroid antibodies and notify them that they have Hashimotos thyroiditis.

    Some of these patients may have had it all along and others may have only developed it recently but its impossible to tell for sure.

    So it may be the case that you already have late stage Hashimotos even if you never knew you had the disease in the first place.

    Its a big bummer if this happens but it does occur from time to time.

    #1. Thyroid Gland Atrophy.

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    What Does Heterogeneous Hypervascular Thyroid Mean

    5/5Heterogeneous thyroidHeterogeneousthyroidthyroid

    Also question is, what does Hypervascular thyroid mean?

    Hypervascularity is an increased number or concentration of blood vessels. In Graves disease, the thyroid gland is hypervascular, which can help in differentiating the condition from thyroiditis. 90% of thyroid papillary carcinoma cases are hypervascular.

    One may also ask, is Hypervascular thyroid normal? On color Doppler, the thyroid can vary from slightly hypervascular to markedly hypervascular . Although this is a focal thyroiditis within a sonographically normal thyroid, it is unusual and represents about 5% of thyroid nodules.

    Keeping this in view, does heterogeneous thyroid mean cancer?

    Background. Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US.

    What does homogeneous thyroid gland mean?

    US Definition and Description of Thyroid NoduleThe echotexture of the normal thyroid is usually homogeneous and bright. A thyroid nodule is defined as a discrete lesion within the thyroid gland that is ultrasonographically distinct from the surrounding thyroid parenchyma .

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    Performance Of Deep Neural Network Model Compared To Radiologists Under Diffused Background

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    For HT subset, the DNN model achieved a higher AUC than that of the three groups of radiologists which showed significant difference as listed in Table 5. However, in the ROC curve , the operation points of the radiologists are close to the DNN models ROC curve. For the other performance metrics, no significant difference was found for accuracy and precision between DNN model and radiologists. The model showed a higher sensitivity and a lower specificity but significant difference only exist between the DNN model and radiologists with < 5 years of experience.

    Table 5 Performance of model versus radiologists of clinical experience < 5 years, 510 years, and > 10 years in diagnosing malignant nodules on the test set and its subsets.

    Figure 5 Performance of DNN model and three groups of radiologists in diagnosing malignant nodules under test set , normal subset , and HT subset .

    Besides, in the test set and normal subset, the model also showed higher AUC but close operation point on the ROC curve compared to radiologists, as shown in Table 5 and Figure 5. The difference of other metrics between model and radiologists was similar to that under HT subset.

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