diffusely heterogeneous thyroid gland

doi:10.1177/030089160809400119, 13. It is usually in the neck, but sometimes it spreads into the thorax and mediastinum. Decreased ability to concentrate and focus. The rest of the physical examination showed no obvious abnormalities. Full thyroid function recovery from postpartum and silent (painless) thyroiditis also takes about 12 to 18 months. The role of thyroidectomy in metastatic disease to the thyroid gland[J]. the left lobe of the the gland measures 6.1x1.5x1.6 cm. If you have subacute, painless (silent) or postpartum thyroiditis and have hypothyroid symptoms, your provider will prescribe thyroid hormone replacement medication. Dr. Jasleen Kukreja and the Life-Saving Gift of Breath, Care, Convenience and Support at New Cancer Facility, 10 Ways to Get the Most Out of Your Doctors Visit, UCSF Health Ranked Among Nation's Top 10 Hospitals, Learn more about our Thyroid and Parathyroid Surgery Clinic, Learn more about our Endocrine Surgery and Oncology Clinic. Postoperative pathology suggested bilateral metastatic thyroid NENs (Figure3) and the immunohistochemical results showed CK[+], TG[-], TTF1 slightly scattered[+], HBME-1[-], S-100[-], Calcitonin[-], CgA[+], Syn[+], Ki-67[+] 10-20%, CK19 [+], CK20[-], PAX 8[-], CEA[-], CDX2[-] and SATB2[-] (Figure4). Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Follows treatment with radioactive iodine for hyperthyroidism or external beam radiation therapy for certain cancers. Thyroid Ultrasound: Diffuse and Nodular Disease - PubMed These include: The presence of heterogenous thyroid echogenicity may reduce sensitivity of detection of thyroid nodules. Survival after renal cell carcinoma metastasis to the thyroid: single center experience and systematic review of the literature[J]. Heterogeneous echogenicity of the underlying thyroid Tumori (2008) 94(1):1103. 1,4 2 3 4 1 Case Report 1 2 3 4 - res.mdpi.com Although the patient had multiple systemic metastases after surgery, there was no obvious recurrence in the neck, and a local cure was achieved, which was consistent with the above literature. Mattavelli F, Collini P, Pizzi N, Gervasoni C, Pennacchioli E, Mazzaferro V. Thyroid as a target of metastases. What is Isoechoic thyroid Colorectal cancer metastases to the thyroid gland-a systematic review: colorectal cancer thyroid metastases[J]. TM has an insidious onset and often has no obvious clinical symptoms. Tang Q, Wang Z. Metastases to the thyroid gland: what can we Do?[J]. By using this Site you agree to the following, By using this Site you agree to the following. doi:10.1007/s40618-020-01282-w, 14. Epub 2020 Sep 17. Youll likely have to take the medication for approximately six to 12 months and then taper off it to see if you have permanent hypothyroidism or not. If the doctor Pol Arch Intern Med (2019) 129(3):2114. Here are the result and was just wondering if anyone could hel 5.5 x 1.5 x 1.3 cm. Homogeneous echotexture is normal for thyroids. Overall throid echogenicity and echo texture are within normal limits. There are multiple small hypoechoic/mixed cystic and solid nodules in the thyroid gland, If you take prescription drugs that can cause thyroiditis, talk to your provider about your risk and if you can stop taking them. Rapid heart rate (tachycardia) that can exceed 140 beats per minute. Zivaljevic V, Jovanovic M, Perunicic V, Paunovic I. Surgical treatment of metastasis to the thyroid gland: a single center experience and literature review[J]. The typical sonographic appearance of MNG 5, 6 is a well-marginated, diffuse enlargement of the thyroid gland with a heterogeneous, nodular appearance Riedel thyroiditis requires surgical treatment. 2020 Nov;58 (6):1041-1057. doi: 10.1016/j.rcl.2020.07.003. Silent or painless thyroiditis is also common in people AFAB and is the next common cause of thyroiditis after Hashimotos thyroiditis. heterogeneous Thyroid nodules are extremely common. In conclusion, clinicians should remain alert to the possibility of TM in patients with thyroid nodules and a history of other malignancies to avoid missed diagnosis, misdiagnosis, and delayed treatment. (B) HE staining demonstrated typical neuroendocrine tumor morphology (HE; 400X). "Diffusely and markedly heterogeneous" means it's lumpy all over. Zhejiang Province science and technology plan projects (grant number 2022KY939). The results of routine laboratory tests, including for those for thyroid function (T3, T4, TSH), liver and kidney function, and tumor markers (AFP, CEA, CA-199, CA-125, CA-153, CA-242), were normal. A goiter can be smooth and uniformly enlarged, calleddiffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter. Thyroiditis: Types, Causes, Symptoms, Diagnosis & Treatment Rojo-Abecia M, Rivera-Alonso D, Herrero-lvarez S, Ochagava-Cmara S, Torres-Garca AJ. (D) Cancer cells positive for Syn (Syn; 400X). In conclusion, the diagnosis of TM should be based on ultrasound, FNAC and the patients past medical history. Masui T, Ito T, Komoto I, Uemoto S. Recent epidemiology of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) in Japan: a population-based study[J]. No bleeding into the Multinodular Goiter: Causes, Treatment, Complications, and More Therefore, clinicians, especially those in Asia, should pay attention to the existence of rectal NENs and the risk of distant metastasis. A goiter can be smooth and uniformly enlarged, called diffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter.Nodules may be solid, filled with fluid, or partly fluid and partly solid. Lumps or bumps in the thyroid gland are called thyroid nodules. The thyroid gland is diffusely heterogeneous and hypervascular. The isthumus is enlarged to 6 mm. If you have Hashimotos thyroiditis, your provider will prescribe thyroid hormone replacement medication, such as levothyroxine. This affects about 5 percent of women in the year after pregnancy. Med (Baltimore) (2019) 98(47):e18043. I also can feel and see an enlargement on the right side. Cleveland Clinic is a non-profit academic medical center. SPot images are available for review. Due to the very low incidence of TM, there are still no guidelines for its treatment. The data of 11,329 patients with NENs in the US SEER database between 1988 and 2012 showed a distant metastasis rate of 2% for tumors with a diameter 10 mm, 2.4% for those with a diameter 11-19 mm, and 12% for those with a diameter 20 mm. my pmd off for a month. However, this is rare in the United States. Sonography of diffuse thyroid disease - Wiley Online Library For example, Stergianos S (21) reported that the survival rate of TM patients was higher when the primary tumor was renal cell carcinoma, versus other types of primary tumors. I had a sono on 9/13/2010 and again on 1/24/2011 due to spasms and a large golf size knot coming up in front of my neck for abut 30 seconds each time this happens. Indian J Endocrinol Metab. (A) Ultrasound showed that there was an isoechoic nodule in the right lobe of the patient, with a size of approximately 2*2 cm, a regular shape, and an uneven halo around the edge. Tsh 0.045. t4 free 1.56. us thyroid shows 1) diffuse heterogeneous thyroid & 2) 6mm solid hypoechoic nodule. If your thyroid cells are damaged quickly and theres a leak of excess thyroid hormone, you might experience symptoms of hyperthyroidism (overactive thyroid), which include: The hypothyroid phase of thyroiditis can be long-lasting and may become permanent. This is the description of the appearance of the thyroid on ultrasound and is most often seen in thyroiditis or inflammation of the thyroid. is it serious? Thyroid nodules are quite common. Most scholars believe that to achieve local neck control or even a cure, surgical treatment is the priority for patients whose thyroid is the only site of metastasis and whose primary cancer can be resected and cured (1517). (C) Cancer cells positive for CgA (CgA; 400X). You still may not be able to avoid thyroiditis. Should get blood tests to make sure not hypo or hyperthyroid. The pain caused by acute infectious thyroiditis and subacute thyroiditis usually can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. Thyroid (2008) 18(6):61524. Sweeney, F.S. Figure1 Ultrasound image and blood flow diagram of the patients lesion. That U/S is not specific, but Hashimoto's glands can look like that. GP: Resources, Data Curation, Writing - Review & Editing. Thyroid (2012) 22(3):25868. FW: Formal analysis, Resources. doi:10.1097/md.0000000000018043, 20. Wu ZH, Dai JY, Shi JN, Fang MY, Cao J. Thyroid metastasis from chondrosarcoma[J]. Thyroid Nodules The chest CT scan revealed a heterogeneous mass measuring 54 58 mm in the anterior mediastinum that extended to the middle mediastinum on the right side of the trachea, which has no connection with the cervical thyroid gland (Figure 2). Can someone tell me what this means? Atrophic Thyroiditis - Cancer Therapy Advisor 7. What is the meaning of thyroid is diffusely heterogeneous in echotexture? Although the thyroid has an abundant blood supply, metastatic thyroid cancer is extremely rare (1, 6, 7). Thank you for taking the time to read my comment. However, there was no basic thyroid disease in this patient, so the cause of metastasis in this patient needs to be further explored. Battistella E, Pomba L, Mattara G, Franzato B, Toniato A. Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience[J]. WebThyroid ultrasound revealed a markedly heterogeneous hypoechoic and hyperemic-appearing thyroid gland with a diffuse increase in blood flow ( Figure 2). C-Cells: Neuroendocrine cells dispersed in the thyroid parenchyma. All laboratory results need to be interpreted in the clinical context and the doctor who ordered the tests is usually in the best position to do that. . Nonshivering thermogenesis: Shunting of energy from substrate (fat, glucose) to heat; driven by the uncoupling protein-1 in brown fat. A heterogeneous (or inhomogeneous) thyroid echotexture is usually from thyroiditis (Either Hashimoto's or Silent/Viral). Metastatic cancer often occurs in thyroid tissue with existing lesions, such as Hashimotos thyroiditis, nodular goiter, and follicular adenoma. Most scholars believe that the prognosis of TM is generally poor. doi:10.1089/thy.2010.0154, 21. Heterogenous means that the thyroid is diverse in character. Homogenous means it's all the same I'm not sure why the uptake and scan would have been opposite, unless things changed between the time you had them how far apart did you have them? How long between the time you were hypo and when you were hyper? Tsh 0.045. t4 free 1.56. us thyroid shows 1) diffuse heterogeneous thyroid & 2) 6mm solid hypoechoic nodule. Ann Surg Oncol (2017) 24(6):15339. doi:10.1245/s10434-013-3282-1, 23. *Correspondence: Ding-cun Luo, ldc65@163.com, These authors have contributed equally to this work, https://doi.org/10.3389/fonc.2023.1024908, Creative Commons Attribution License (CC BY). Therefore, it is recommended that regular and timely general examinations be conducted after the discovery of TM and that the frequency of examinations should be increased. Heterogeneity: Heterogeneous means the size is irregular in terms of thickness throughout. WebThyroid Ultrasound: Diffuse and Nodular Disease Radiol Clin North Am. Thyroid Thyroid A 56-year-old woman presented with neck pain 1 month after the discovery of a thyroid nodule that developed 1 year prior. What does diffusely heterogeneous thyroid gland mean? The thyroid gland is homogeneous in echotexture. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. doi:10.24875/ciru.19001130, 5. The thyroid gland is diffusely heterogeneous and hypervascular. Youll likely have to take this medication for the rest of your life since the hypothyroidism from Hashimotos thyroiditis is usually permanent. Correlate with thyroid function studies as needed: Real time imaging of the thyroid gland was performed. Type B. In May 2017, the patient underwent enteroscopy because bloody stools for 8 months and aggravated for the last 2 months. Muscle, adipose tissue, nerves, and vascular spaces. Cancers (Basel) (2022) 14(12):3017. doi:10.3390/cancers14123017, 3. Fibrosis (thickening and scarring) of your thyroid. What does Thyroid parenchyma is diffusely and markedly heterogeneous mean? (A) The patients preoperative colonoscopy images. The faster blood flow in the thyroid prevents the adhesion of cancer cells. no financial relationships to ineligible companies to disclose. I have nit seen the scan. WebThe US patterns were classified into 4 grades to compare the thyroid echogenicity and anterior strap muscle echogenicity, which was used as a reference: Grade 1 (G1): diffusely enlarged gland with a normoechoic US pattern (similar to normal tissue, and to the submandibular gland, hyperechoic to the anterior strap muscle) ( Fig. The patient and their family chose to have regular follow-up examinations without further treatment for the thyroid nodules. Thyroiditis: Types, Causes, Symptoms, Diagnosis & Treatment Further inquiries can be directed to the corresponding author. Can you help me interpret my ultrasound report? Thyroid Parenchyma Heterogeneous echogenicity of the thyroid gland is a non-specific finding and is associated with conditions diffusely affecting the thyroid gland. Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, et al. For these, please consult a doctor (virtually or in person). Chung AY, Tran TB, Brumund KT, Weisman RA, Bouvet M. Metastases to the thyroid: a review of the literature from the last decade[J]. last week gland swollen/tender. However, treatment may be necessary for goiters or nodules that are causing bothersome symptoms or health concerns, such as the production of too much or too little thyroid hormone. The right lobe measures 3.1 cm in maximal dimension and is diffusely heterogeneous. WebWhat does diffusely enlarged heterogeneous thyroid gland mean? Hypoechoic Nodule on Thyroid Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Copyright 2023 Elsevier B.V. or its licensors or contributors. Willis RA. Straccia P, Mosseri C, Brunelli C, Rossi ED, Lombardi CP, Fadda G, et al. "The thyroid parenchyma" is the main part of your thyroid gland. doi:10.1111/j.1365-2265.2007.02773.x, Keywords: neuroendocrine tumor, neoplasm metastasis, thyroid gland, rectal cancer, FNA, Citation: Zhang Y, Lin B, Lu K-n, Teng Y-p, Zhou T-h, Da J-y, Wu F, Pan G and Luo D-c (2023) Neuroendocrine neoplasm with metastasis to the thyroid: a case report and literature review. HT may show as poorly defined, patchy hypoechoic areas and micronodular patterns consisting of Cancer Cytopathol (2015) 123(1):1929. According to Tang Q (2), who reviewed the literature from 1979 to 2021, the most common origins of metastasis in these patients were renal cell carcinoma (48.1%), colorectal cancer (10.4%), lung cancer (8.3%), breast cancer (7.8%) and sarcoma (4.0%). 2. What Does It Mean If Your Thyroid Is Heterogeneous? The other types of thyroiditis are rarer. Considering that there was no evidence of distant metastasis, bilateral thyroid nodules were present, and the possibility of malignancy was confirmed by left puncture, bilateral total thyroidectomy and bilateral central lymph node dissection were performed for this patient at our hospital. Diagnosis and treatment of metastases to the thyroid gland: a meta-Analysis[J]. Papi G, Fadda G, Corsello SM, Corrado S, Rossi ED, Radighieri E, et al. Conversely, involvement of the contralateral lateral and specifically the infrabrachiocephalic upper mediastinal compartment indicates advanced, usually systemic disease.5 Lymphatic tumor cell dissemination conceivably progresses via posterior central lymph nodes in the paraesophageal area to ipsilateral lateral lymph nodes, or alternatively via direct lymphatic channels to the lateral jugular chain, as noted in upper thyroid pole primaries.29, The more lymph nodes are involved, the greater are the odds that one of the lymph node metastases happens to breach its nodal capsules to invade adjoining soft tissues.26 Quantitative assessment of lymph node metastases, in increments of 110 (N1), 1120 (N2), and >20 (N3) involved lymph nodes, is an important prognostic classifier. doi:10.1001/jamanetworkopen.2021.24750, 12. why sore? Thyroid gland enlargement is usually diffuse and symmetric. WebEnter the email address you signed up with and we'll email you a reset link. All authors contributed to the article and approved the submitted version. good luck to you, I came across this. Zhejiang Province Basic Public Welfare Research Program Project (grant number GF22H165705). The result of enteroscopy suggested a rectal mass (Figure2A) and the patient had previously undergone radical rectal resection for a rectal neuroendocrine neoplasm (NEN). If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. What Do Herpes Sores Look Like at Different Stages. Can anyone help read my ultrasound results? For the best experience, try Chrome or Firefox. If you develop worse or more concerning symptoms, call your provider as soon as possible. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. When palpating the thyroid gland in this patient, bilateral hard masses could be felt, measuring approximately 1.5*1.5 cm in size, with an unclear boundary, tenderness and rigidity, and the masses moved up and down with swallowing. Common causes of an inflamed thyroid include autoimmune thyroiditis (also called Hashimoto's thyroiditis), which occurs when the person's immune system attacks its own thyroid, causing swelling and inflammation. Sholosh B & Borhani A. Thyroid Ultrasound Part 1: Technique and Diffuse Disease. If they're positive, it's Hashimo No undue risk of cancer. STIs are the most common cause of genital sores. Int J Mol Sci (2022) 23(6):3242. doi:10.3390/ijms23063242, 10. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-32569. This will likely involve antibiotics. If youre experiencing symptoms of thyroiditis, its important to talk to your healthcare provider so they can order tests to diagnose it and treat it. There is a 0.8 cm hypoechoic complex nodule in the lower pole. The symptoms of thyroiditis depend on the type of thyroiditis and its phase. T-HZ: Resources, Data Curation, Supervision. However, a life-threatening condition called thyroid storm can develop if you have long-term untreated or undertreated hyperthyroidism, which can develop from thyroiditis. Oxaliplatin 130 mg D1+ S-1 60 mg d1-7 (SOX), anlotinib, irinotecan 260 mg d1 q2w and other drugs were used successively. Fibrosing process is not confined to thyroid but also involves extrathyroidal connective tissue structures, such as. Thyroid Thyroid peroxidase antibodies: Markers of thyroid autoimmunity. Although some cases present with multinodular goiter or autoimmune thyroiditis, the exact cause has not yet been elucidated. In January 2019, liver metastases were detected in another examination, followed by multiple metastases in bone and the pelvis. new u/s diffusely n moderately inhomogeneous. Your provider may switch you to a different but similar medication to treat the thyroiditis or they may prescribe levothyroxine (thyroid hormone medication) while you continue to take the medication causing thyroiditis. This article reports the diagnosis and treatment of a rectal neuroendocrine neoplasm metastasis to the thyroid. Fine-needle aspiration biopsy of secondary neoplasms of the thyroid gland: a multi-institutional study of 62 cases[J]. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. This causes hyperthyroidism. NENs are rare and highly heterogeneous tumors originating from neuroendocrine organs or cells. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. There appears to be wide molecular heterogeneity involving several causative genes. Thyroid (2015) 25(3):31424. Amante MA, Real IO, Bermudez G. Thyroid metastasis from rectal adenocarcinoma[J]. This chart lists the causes for each type of thyroiditis. It is worth noting that most TM patients have multiple systemic metastases at the same time (1820), and a study by Stergianos S (21) noted out that 81% of patients will have metastases in parts of the body other than the thyroid. . Heterogeneous thyroid echotexture. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. This may be related to renal cell carcinoma having a low degree of invasiveness and malignancy. YZ: Conceptualization, Methodology, Resources, Formal analysis, Writing - Review & Editing. We do not endorse non-Cleveland Clinic products or services. Authors Lauren F Alexander 1 , Neema J Patel 2 , Melanie P Caserta 2 , Michelle L Robbin 3 Affiliations 1 Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, doi:10.1007/s42000-020-00255-1, 16. diagnosis? Thyroid us: diffusely heterogeneous thyroid w/o well-defined dominant nodule, isthmus enlarged. Diffuse Thyroid Disease (DTD) and Thyroiditis | Radiology Key Thyroid gland diffusely heterogeneous, with a 3mm cyst in left thyroid lobe, what does that mean?? Meds will be adjusted based on your. D-CL: Resources, Supervision, Project administration, Writing - Review & Editing, Funding acquisition. Worldwide, the most common cause is not enough iodine in the diet. Deiodinases: Enzymes that convert the prohormone T4 into T3 or rT3. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. a case of foregut neuroendocrine carcinoma with multiple abdominal metastases and a thyroid localization after 21 years[J]. From: Surgery of the Thyroid and Parathyroid Glands (Third Edition), 2021, In Diagnostic Pathology: Intraoperative Consultation (Second Edition), 2018, Parathyroid parenchyma can resemble thyroid parenchyma, Pseudofollicular and trabecular structures can be present, Pseudofollicles can contain eosinophilic material that simulates colloid, Oxyphilic cells can resemble Hrthle cell nodule of thyroid, Features helpful to identify true parathyroid parenchyma, Cells smaller and more vacuolated than thyroid cells, Nuclei have rounder and denser chromatin than thyroid nuclei, Lack birefringent and polarizable calcium oxalate crystals seen in thyroid, Pseudofollicles can contain material that closely mimics colloid, Thyroid parenchyma can resemble parathyroid parenchyma, Stromal edema or ice crystal artifact can simulate adipose tissue, Rarely, true adipose metaplasia can be present within thyroid tissue, Hrthle cells of thyroid can be mistaken for oxyphil cells, True thyroid follicles often contain calcium oxalate crystals that are easily seen with polarization, Calcium oxalate crystals are not seen in parathyroid tissue, Ice crystal artifact can mimic adipose tissue within lymph node and mimic parathyroid gland, Parathyroid tissue has more cytoplasm than lymphocytes, Assessing cellularity in small biopsies can be difficult, Variable within parathyroid glands and among glands in single individual, Polar regions of parathyroid more cellular than central, Cellularity increases with age and varies with gender, ethnicity, and body habitus, In Imaging Anatomy: Ultrasound (Second Edition), 2018, Normal thyroid parenchyma has fine, uniform echoes and is hyperechoic compared to adjacent muscles, Echogenic thyroid capsule is clearly visualized and helps to differentiate thyroid lesions from extrathyroidal masses, Both longitudinal and transverse scans are required for comprehensive ultrasound assessment of thyroid gland, Transverse scan helps to locate thyroid nodules, their relationship to trachea, major vessels in carotid sheath, and to evaluate internal architecture and extrathyroid extension, Longitudinal scan helps to evaluate internal architecture, vascularity on Doppler, and extrathyroidal extension, Assessment of adjacent structures (including trachea, esophagus, strap muscles, carotid artery, and internal jugular vein) and cervical lymph nodes, In Diagnostic Pathology: Head and Neck (Second Edition), 2016, Destruction and replacement of thyroid parenchyma by dense collagen (keloid-like bands of fibrosis), Fibrosing process is not confined to thyroid but also involves extrathyroidal connective tissue structures, such as, Muscle, adipose tissue, nerves, and vascular spaces, In addition to fibrosis, chronic inflammatory cell infiltrate is present, Predominantly composed of mature plasma cells and lymphocytes; eosinophils may be present, Vasculitis is present primarily involving veins (phlebitis) characterized by adventitial inflammation that may invade through full thickness of vessel wall with thrombotic effect, May be readily apparent or may be difficult to identify; not present in all cases, Remnant of thyroid follicles may be present (but may be difficult to identify), Not associated with oxyphilic metaplasia (as seen in chronic lymphocytic thyroiditis) or granulomatous inflammation, In some cases, preexisting or coexisting lesions may be present, e.g., adenomatoid nodule(s), follicular adenoma, follicular carcinoma, thyroid papillary carcinoma, Vania Nos MD, PhD, in Diagnostic Pathology: Endocrine (Second Edition), 2018, Reactive histologic features present in thyroid parenchyma, Absence of follicular cells within needle tract in addition to other reactive features indicates PFNAC, Cells with reactive atypia may become dislodged into vessels mimicking appearance of vascular invasion, Andreas Machens MD, PhD, Henning Dralle MD, PhD, in Advances in Treatment and Management in Surgical Endocrinology, 2020, Invasive growth emerges from within the thyroid parenchyma (extrathyroidal extension) or from within the lymphatic mesenchyma (extranodal growth).26 Two types of locoregional soft tissue infiltrates are to be distinguished: (1) by direct extension of, and/or venous microembolization from, a primary tumor penetrating the thyroid capsule, more commonly seen in the central neck; and (2) by growth of lymph node metastases through the nodal capsule, more often found in the lateral neck.27, Primary tumor size >20mm is independently associated with histology-proven lymph node recurrence.

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