Ultrasound neck and thyroid

Thyroid, cervical nodal levels, salivary glands as indicated

When to use it

High-frequency linear transducer, typically in the 7-15 MHz range; a lower-frequency curvilinear or small-footprint probe is added for a large goitre or to reach behind the clavicle.
Patient supine with the neck extended over a pillow or pad placed under the shoulders — the extension is what brings the lower poles and the isthmus out from behind the sternum, and a study done with the head flat is the usual reason a lower pole is called "not seen".
Both lobes and the isthmus swept in transverse and longitudinal planes; each lobe measured in three dimensions and each reported nodule measured in three dimensions, since the maximum diameter drives the size threshold for biopsy.
Each nodule characterised against the features the risk-stratification systems use: composition, echogenicity, shape (taller-than-wide on the transverse image), margin, and echogenic foci — ACR TI-RADS in North America, and British Thyroid Association U-classification or EU-TIRADS elsewhere. State which system was applied, because the biopsy thresholds are not interchangeable.
Cervical nodal levels are surveyed in the same sitting where the question is malignancy or a neck lump, with attention to levels III, IV and VI for thyroid primaries; loss of the fatty hilum, rounded shape, cystic change and punctate calcification are the abnormal features.
Colour Doppler for vascularity, and a swallow manoeuvre where retrosternal extension or a mobile mass is in question.

Ultrasound cannot assess retrosternal extension or deep spaces — a substernal goitre needs cross-sectional imaging.

None