What information should be included in a thyroid ultrasound order?

Essential Information for Thyroid Ultrasound Orders

When ordering a thyroid ultrasound, clinicians should specify the clinical indication, examination type, and areas to evaluate, including the thyroid gland, central neck compartment, and cervical lymph nodes. 1

Required Components for Thyroid Ultrasound Orders

Clinical Information

• Specific clinical indication:

  • Palpable thyroid nodule
  • Incidental nodule found on other imaging
  • Nodule causing clinical symptoms (compression, dysphagia, etc.)
  • Nodule ≥2cm in diameter
  • Autonomously functioning thyroid nodule
  • Recurrent nodule after previous treatment
  • Monitoring of known thyroid disease
  • Suspicious clinical features (firm nodule, fixed to adjacent structures, rapidly growing)
  • Associated lymphadenopathy or vocal cord paralysis 1

• Relevant patient history:

  • History of head and neck irradiation
  • Family history of thyroid cancer
  • Associated syndromes
  • Age <15 years (higher risk)
  • Male gender (higher risk) 1

Specific Assessment Requests

• Request for assessment of:
  • Nodule characteristics (size in three dimensions, echogenicity, composition)
  • Vascularity pattern
  • TI-RADS risk stratification
  • Relationship to adjacent structures
  • Extrathyroidal extension (if malignancy suspected)
  • Cervical lymphadenopathy 1, 2

Standardized Reporting Elements to Request

The order should request documentation of the following for each thyroid lesion 2:

• Position within the gland
• Extracapsular relationships
• Number of nodules
• Shape of each nodule
• Internal content (solid, cystic, mixed)
• Echogenicity (hyper-, iso-, hypo-, or anechoic)
• Echotexture (homogeneous or heterogeneous)
• Presence of calcifications (micro or macro)
• Margins (well-defined, poorly defined, irregular)
• Vascularity pattern
• Size in three dimensions

Importance of Comprehensive Assessment

Requesting a comprehensive ultrasound assessment is critical as certain features are associated with higher malignancy risk 3:

• Microcalcifications
• Hypoechogenicity
• Irregular margins or absent halo sign
• Solid composition
• Intranodular vascularization
• Shape (taller than wide)

Common Pitfalls to Avoid

• Lack of specificity in the order: Vague orders like "thyroid ultrasound" without specific indications may result in incomplete assessment 1

• Overreliance on size measurements alone: While size is important, ultrasound measurements have limitations and should not be the sole criterion for clinical decision-making 4

• Failure to request lymph node assessment: Cervical lymph node evaluation should be specifically requested, especially when thyroid malignancy is suspected 5

• Not providing relevant clinical context: Including relevant clinical information helps the radiologist focus on areas of concern 1, 2

• Omitting request for TI-RADS classification: This standardized risk stratification system helps guide further management decisions 1

Follow-up Recommendations

When ordering follow-up ultrasounds for known nodules, include:

• Previous ultrasound date and findings
• Specific request to compare with prior studies
• Request for volume calculation to assess growth over time 4

By providing comprehensive information in thyroid ultrasound orders, clinicians can ensure appropriate assessment and facilitate accurate diagnosis and management of thyroid pathology.