KEY FACTS
Imaging
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Multiple nodules with bilateral diffuse involvement
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Solid nodules most often isoechoic; 5% hypoechoic
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Nodules are sharply defined with haloes but may conglomerate
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Heterogeneous internal echo pattern: Solid/cystic portions, internal debris, septa, “spongiform” nodules
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Cystic component due to degeneration, hemorrhage, or colloid within nodule
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Dense shadowing calcification (curvilinear, dysmorphic, coarse)
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Nodules with comet-tail artifact; highly suggestive of colloid nodule (may mimic microcalcification)
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Background thyroid may be heterogeneous
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Color Doppler: Peripheral > intranodular vascularity
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Septa and intranodular solid portions are avascular (organizing blood, clot)
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Top Differential Diagnoses
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Papillary and follicular carcinoma
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Anaplastic and medullary thyroid carcinoma
Clinical Issues
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Incidence of sporadic multinodular goiter (MNG): ~ 5% in US
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Sporadic goiter has no specific age incidence, F:M = 2-4:1
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Most asymptomatic and euthyroid
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Can become hyperthyroid or hypothyroid
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Symptoms related to mass effect: Airway compression, hoarseness, dysphagia, and superior vena cava syndrome
Scanning Tips
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Change transducer frequency to evaluate colloid, calcification and cystic components
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Use curvilinear transducer if thyroid is too large for linear transducer
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Look for suspicious nodules
. The trachea 
is displaced to the right.
