Single article

DOI: 10.47026/2413-4864-2023-4-100-106

Timofeeva L.A., Stepanov V.G., Kleverova L.S.

Ultrasound sign «calcification» of nodular thyroid neoplasms when using the TI-RADS system (case report)

Keywords: nodular formation of the thyroid gland, multiparametric ultrasound examination, calcifications, TI-RADS

The problem of improving the quality of early differential diagnosis of thyroid nodules remains relevant, since the number of patients with this pathology is steadily increasing. Obtaining reliable criteria for node malignancy is clinically significant for carrying out further therapeutic and diagnostic measures. In the case of detecting calcifications during ultrasound examination of the thyroid gland, the choice of tactics becomes more complicated, since today there is no unified understanding of the value of calcifications, and contradictions in their assessments persist. The aim is to demonstrate the complexity of differential diagnosis of nodular thyroid pathology using the clinical example. Results. The article presents a clinical case which is complex from a diagnostic point of view; it is a clinical case of nodular thyroid pathology in a patient aged 71 years. To make the diagnosis, a multiparametric ultrasound examination was performed in В-mode. Based on the results of multiparametric ultrasound examination, indications for a fine needle aspiration biopsy were determined and further management for the patient with nodular thyroid formation was determined. The results of the multiparametric ultrasound examination were ambiguous. In B-mode, the nodes were characterized by a hypoechogenic heterogeneous structure with multiple cystic cavities with intersections and microcalcifications. Taking into account these signs, the nodes were assessed as malignant (TI-RADS4). The patient underwent a fine needle aspiration biopsy, the results of which indicated goiter with signs of regressive changes (Bethesda II). The conclusion of the pathomorphological study indicated stromal calcinosis. Conclusions. Taking into account the ultrasound sign of "calicificates" made it possible to more accurately assess the nature of pathomorphological changes in the nodes in the right (TI-RADS4) and left (TI-RADS4) lobes of the thyroid gland, which was then confirmed by a pathomorphological study. Thus, multiparametric ultrasound remains the leading method in the diagnosis of nodular thyroid pathology.

References

  1. Aleksandrov Yu.K., Yanovskaya E.A., Shubin L.B., Dyakiv A.D. Effektivnost’ stratifikatsionnykh sistem v diagnostike uzlovykh zabolevanii shchitovidnoi zhelezy [The Effectiveness of Risk Stratification Systems in Diagnosis of Nodular Thyroid Disorders]. Problemy endokrinologii, 2019, vol. 65(4), pp. 216–226. DOI: 10.14341/probl10087.
  2. Fisenko E.P, Sych Yu.P., Zabolotskaya N.V. et al. Klassifikatsiya TI-RADS v otsenke stepeni zlokachestvennosti uzlov shchitovidnoi zhelezy: metodicheskoe posobie dlya vra-chei ul’trazvukovoi diagnostiki [Classification of TI-RADS in the assessment of the degree of malignancy of thyroid nodules: a methodological manual for ultrasound diagnostics doc-tors]. Moscow, Firma STROM Publ., 2020, 56 p.
  3. Sencha A.N., Sencha E.A., Penyaeva E.I., Timofeeva L.A. Ul’trazvukovoe issledova-nie shchitovidnoi zhelezy. Shag za shagom. Ot prostogo k slozhnomu [Ultrasound examination of the thyroid gland. Step by step. From simple to complex]. Moscow, MEDpress-inform Publ., 2019, 208 p.
  4. Timofeeva L.A., Aleshina T.N. Diagnosticheskaya taktika pri uzlovykh obrazovaniyakh shchitovidnoi zhelezy na osnove sistemy TI-RADS [Diagnostic Tactics with Palpable Thyroid Abnormalities Based on TI-RADS System]. Acta Medica Eurasica, 2017, no. 4, pp. 37–44.
  5. Timofeeva L.A., Sencha A.N. Mul’tiparametricheskoe ul’trazvukovoe issledovanie s primeneniem klassifikatsii TI-RADS v opredelenii diagnosticheskoi taktiki pri tireoidnykh uzlovykh obrazovaniyakh [Multi-Parametric Ultrasonic Examination Using TI-RADS Classification in Determining Diagnostic Tactics IN Thyroid Nodular Palpable Abnormalities]. Prakticheskaya meditsina, 2018, no. 1(112), pp. 134–139.
  6. Caulley L., Eskander A., Yang W. et al. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg., 2022, vol. 148(2), pp. 99–106. DOI: 10.1001/jamaoto.2021.3277.
  7. Drake T., Caicedo-Granados E. Most Thyroid Surgeries Start With an Asymptomatic Patient. JAMA Otolaryngol Head Neck Surg., 2022, vol. 148(9), pp. 818–819. DOI: 10.1001/­jamaoto.2022.1744.
  8. Garber J.R., Papini E., Frasoldati A. et al. American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool. Endocr Pract., 2021, vol. 27(7), pp. 649–660. DOI: 10.1016/j.eprac.2021.04.007.
  9. Grani G., Sponziello M., Pecce V. et al. Contemporary Thyroid Nodule Evaluation and Management. J Clin Endocrinol Metab., 2020, vol. 105(9), pp. 2869–2883. DOI: 10.1210/clinem/dgaa322.
  10. Shalaby M., Hadedeya D., Lee G.S. et al. Impact of Surgeon-Performed Ultrasound on Treatment of Thyroid Cancer Patients. Am Surg., 2020, vol. 86(9), pp. 1148–1152. DOI: 10.1177/00031348­20945229.
  11. Toumi A., Di Gennaro C., Vahdat V. et al. Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007–2018. Thyroid., 2021, vol. 31(6), 941–949. DOI: 10.1089/thy.2020.0643.
  12. Welkoborsky H.J., Jecker P. Ultrasonography of the Head and Neck. An Imaging Atlas. Springer International Publishing, 2019, 365 p. DOI: 10.1007/978-3-030-12641-4.

About authors

Timofeeva Lyubov A.
Doctor of Medical Sciences, Professor, Department of Propaedeutics of Internal Diseases with a Course of Radiation Diagnostics, Chuvash State University, Russia, Cheboksary (adabai@mail.ru; ORCID: https://orcid.org/0000-0002-4707-8214)
Stepanov Vladimir G.
Minister, Ministry of Health of the Chuvash Republic, Russia, Cheboksary (medicin_prm@cap.ru; )
Kleverova Lyudmila S.
Radiologist, Chief Freelance Specialist in Radiation Diagnostics, Republican Clinical Oncology Dispensary, Russia, Cheboksary (rkod@med.cap.ru; )

Article link

Timofeeva L.A., Stepanov V.G., Kleverova L.S. Ultrasound sign «calcification» of nodular thyroid neoplasms when using the TI-RADS system (case report) [Electronic resource] // Acta medica Eurasica. – 2023. – №4. P. 100-106. – URL: https://acta-medica-eurasica.ru/en/single/2023/4/10/. DOI: 10.47026/2413-4864-2023-4-100-106.