COMPUTED TOMOGRAPHY

CT scan combines a series of X-ray images taken from different angles and uses computer
processing to create cross-sectional images, or slices, of the bones, blood vessels and soft
tissues inside your body. CT scan images provide more detailed information than plain X-rays
do.
Similarly to MRI, CT is not a sensitive technique for demonstrating intrathyroid lesions.
However, CT is useful in evaluating lymphadenopathy, local tumor extension, and extension into
the mediastinum or retrotracheal region. It is used for staging. Attempts to differentiate benign
from malignant nodules by measuring the iodine content and enhancement characteristics of
the nodules on CT scans have been unsuccessful. There can also be use of ionizing radiation
which, in high doses, increases the risk of cancers, specifically thyroid cancer
CT of the thyroid is neither sensitive enough nor specific enough to allow the characterization of
thyroid nodules. Thyroid cancer is suggested when certain patterns of calcification are seen in a
thyroid mass and when extension to the surrounding soft tissues is visualized.
Clinical Implication:
Thyroid cancers may be missed on CT scans in the presence of a multinodular goiter. An
intrathyroidal parathyroid gland and/or adenoma may lead to a false-positive diagnosis of
thyroid cancer.
Nursing interventions:
Before procedure - Advise the client to take off some or all of your clothing and
wear a hospital gown. Remove metal objects, such as a belt, jewelry, dentures and
eyeglasses, which might interfere with image results. Refrain from eating or drinking for
a few hours before your scan.
During procedure - CT scanners are shaped like a large doughnut standing on its
side. Let the client lie on a narrow, motorized table that slides through the opening into a
tunnel. Provide Straps and pillows to the client to help stay in position. The client may be
ask to hold breath at certain points to avoid blurring the images.

 After procedure - After the exam advise the client that he/she can return to
his/her normal routine. If given a contrast material, you may receive special instructions.
In some cases, the client may be asked to wait for a short time before leaving to ensure
that he/she feel well after the exam. After the scan, the client likely be told to drink lots of
fluids to help kidneys remove the contrast material from your body.

ULTRASONOGRAPHY

The visualization of deep structures of the body by recording the reflections or echoes of
ultrasonic pulses directed into the tissues.
The use of high-frequency 12- or 15-MHz transducers has become the standard for
interrogating the parathyroid glands. The examination should proceed from the carotid
bifurcation superiorly to the sternal notch inferiorly and the carotid artery/internal jugular vein
laterally.Normal-sized parathyroid glands are usually not visualized with ultrasound. On grayscale images, parathyroid adenomas appear as a discrete, oval, anechoic or hypoechoic
masses. Color Doppler ultrasound has been used to localize enlarged parathyroid glands.
Parathyroid adenomas tend to be hypervascular lesions.
Clinical Implication:
False-positive findings result when thyroid nodules, enlarged lymph nodes, the esophagus,
longus colli muscles, and perithyroid veins are mistaken for enlarged parathyroid glands.
False-negative studies result from small parathyroid glands; ectopic locations lacking an
adequate acoustic window; and poor visualization of neck structures due to previous surgery,
thyromegaly, or body habitus.
Nursing intervention:
Before procedure - Client may be told to eat a fat-free meal the evening before
your test and then to fast until the procedure. However, can continue to drink water and
take any medications as instructed. Be sure to tell your doctor about any prescription
drugs, over-the-counter medications, and herbal supplements that you take before the
exam.

 During procedure - The patient should be supine with his or her neck
hyperextended.
After procedure - After the procedure, the gel will be cleaned off your abdomen.
Remind the client that the doctor will review the images and check for any abnormalities.
He or she will call you to discuss the findings, or to schedule a follow-up appointment.
Should anything abnormal turn up on the ultrasound, may need to undergo other
diagnostic techniques, such as a CT scan, MRI, or a biopsy sample of tissue.