How does an ultrasound diagnose toxic goiter?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
Strictly speaking, an ultrasound does not diagnose toxic goiter.  An ultrasound can diagnose a goiter -- thyroid enlargement -- and can identify thyroid nodules. But a goiter is “toxic” when it overproduces thyroid hormone. An ultrasound only gives information about thyroid anatomy, not thyroid function. A toxic goiter can be diagnosed though a combination of blood tests for thyroid hormone and a nuclear medicine test called a thyroid scan and radioactive iodine uptake. This two-part test gives functional information -- i.e., one can see how much iodine the thyroid is extracting from the blood. This is an indication of how much thyroid hormone is being produced. One can also see where the iodine is going within the thyroid gland.  

In the case of Graves’ disease, the whole thyroid gland tends to extract an increased amount of iodine from the blood. This will show up on the nuclear medicine test as higher amount of iodine than normal accumulating uniformly throughout the thyroid gland. In the case of a toxic nodular goiter different areas of the thyroid, corresponding to normal areas of the thyroid or individual nodules, usually accumulate different amounts of iodine so that the appearance is not uniform.  

Determining the cause of hyperthyroidism, including which form of toxic goiter a patient may have, is an important first step in deciding on therapy.

An ultrasound uses sound waves to create an image of your thyroid. Your doctor will move an ultrasound transducer near your neck. This enables your doctor to see the shape of your thyroid.

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