The presentation of lymph nodes in Hashimoto's thyroiditis on ultrasound

Background: Comprehensive neck ultrasound (US) examination has become an essential component of preoperative workup for patients with thyroid cancer. Regional cervical lymph nodes may be involved in cases of Hashimoto's thyroiditis (HT). This study seeks to examine the sonographic pattern of lymph nodes in patients with HT. Methods: This is a retrospective study looking at patients with confirmed diagnoses of HT on final surgical pathology who underwent preoperative comprehensive neck US. We compared preoperative ultrasound for patients with HT to euthyroid patients with goiter. Data collected included number, size and ultrasonographic features of cervical lymph nodes. Results: We included a total of 417 patients: 202 patients with HT in the study group, and 215 patients with goiter and euthyroid status in the control group. Patients with HT had a higher number of total cervical lymph nodes than the control group (2.00 +/- 2.35 vs. 0.76 +/- 1.36 mm; P<0.0001), most notably in cervical levels III and IV (P<0.05 for both). Conclusions: HT seems to be associated with an ultrasonographic pattern of increased number of enlarged cervical lymph nodes, particularly in levels III, and IV.