Nodous Goiter vs. Goiter in Graves´ Disease

Left picture: The clinical diagnosis is a nodous goiter, with a cyst of the left thyroid lobe visible in ultrasound being crucial for making the diagnosis. The alternative diagnosis is a solitary thyroid nodule. Right picture: In this teenager a general enlargement of the thyroid is present in a Graves´ disease without an alteration of the structure.

Left picture: 14.1-year-old girl with enlargement of the left thyroid lobe. Ultrasound of the thyroid with demonstration of the right and left lobe in the longitudinal direction: In contrast to the right lobe with a homogeneous structure and a longitudinal extension of 5.8 by 35.4 mm, the left lobe has - except for the upper pole - an inhomogeneous structure, and is in the dorso-ventral and longitudinal extension (20.5 by 46.1 mm) larger than the right lobe. The reason for the structure alteration of the left lobe is - among other things - a cavity which is very distinctly recognizable in the transverse ultrasound; this part of the lobe measuring 23.8 mm is twice as big as the right thyroid lobe. Right picture: 15-year-old girl with restlessness, lassitude, muscular weakness, and loss of weight in spite of good appetite. Ultrasound of the thyroid with demostration of the left and right lobe and the isthmus: The different parts of the thyroid have a homogeneous structure, and are enlarged. The left lobe measures in dorso-ventral and longitudinal direction 17.1 by 61.0 mm, the right lobe 18.2 by 65.3 mm, and the Isthmus 6.6 by 21.6 mm.