Lobulated Heterogeneous Thyroid

Let’s start with discussing what a Lobulated heterogeneous thyroid means.

Lobe is defined as any of the main divisions of an organ separated by fissures, e.g. a lobe of the brain, lung, or liver. So lobes are small, mostly rounded, divided compartments of any organ. Lobules are further subdivisions of lobes. Hence lobulated appearance of thyroid on ultrasound implies a thyroid surface with multiple, rounded and small projections.

Normal Thyroid

Normal thyroid is Homogeneous in texture. It has two lobes, one on right and the other on the left side. There’s a band of normal thyroid tissue connecting the two. This band is called the isthmus.

Heterogenous Thyroid

Heterogeneous means that thyroid appears to be composed of unrelated or varied elements. For example; heterogeneous areas of fibrosis, cysts, hemorrhage, necrosis etc.

It is not normal for a thyroid to show heterogeneity. However, as we age up, some areas of the gland may become necrosed or fibrosed. That’s normal.

In general, a Heterogenous thyroid needs to be investigated further. Some areas of the gland may be inflamed, as is Thyroiditis, There may be nodules in there, which may be toxic or non toxic.

It’s difficult to comment upon the exact nature of the disease, solely on the basis of ultrasonographic appearance. The diagnosis typically requires microscopic examination of thyroid tissue, obtained through biopsy.  Clinical correlation is done to make the diagnosis. But heterogeneous areas may sometimes be seen with various tumors.

Ultrasound Findings Common With Malignancy

Presence of solitary nodes drives more attention towards investigation. Multiple nodules are usually seen in benign states, though exceptions may be seen in papillary carcinomas of the thyroid.

Whether the node is Solid or Cystic- Cystic nodes, in general, point towards benignity. They develop when a focal area of the gland suffered hemorrhage or undergoes a cystic degenerative change. Solid nodules need to be investigated cautiously.

If calcified, the pattern of calcification needs to be studied carefully. A fine microcalcification or a ‘punctate’ calcification may imply malignancy. While, coarse calcification, especially along the margins of the lesion are mostly benign.

Margins of the lesion being observed needs to be studied. Irregular margins, showing a halo around them calls for malignant change.

Classic “Comet tail” appearing lesions of thyroid tissue are considered benign.

Medical Advice (Q&As) on “Lobulated Heterogeneous Thyroid

  1. Rebecca Balinggao

    Hi doctor, I had throat ultrasound size is right 6.6 left 6.9 width right is 2.7 left is 3.1 thickness is right 2.0 left 2.3, Isthmus thickness is .17, impression was bilateral multinodular thyroid disease, sonographically normal submandibular glands. My doctor said if I want it removed it can be done by surgery. I’m afraid for any complication after am worried what to do, the result also of my T3, T4, TSH according to my doc has no problem. Is there any other way or medication that said cyst will be removed aside from surgery?

    1. Buddy M.D. Post author

      There are no medications to remove the cyst. Surgery is the only option.

      Choose a skilled surgeon for the surgery, as the area is sensitive.

    2. erica

      r thyroid lobe measure 5.6 x 1.6 x 2.3cm. left thyroid lobe 5.4 x 2.1 x 2.3cm. thyroid isthmus 0.4 anterposteriorly. multiple bilateral thyroid nodules are present including several anechoic cystic nodules. a dominant solid appearing hypoechoic 7 x 6 x 6 mm nodule upper pole right thyroid lobe is present

  2. lynn kobos

    The right lobe of the thyroid gland is 2.9 cm length x 9 mm Ap transverse diameter 9mm. The thyroid isthmus is somewhat small and is approximately 1.5 mm the left lobe of the thyroid gland is 2.4 x 0.7×0.7 yjete is no surrounding lymphadenopathy identified.

    In pression diffusely small and slightly lobulated thyroid gland with no nodules no visible lymphadenopathy..

    I’m trying to figure out what this means is my Hashimoto’s eaten up most of my thyroid at this point?

    1. Buddy M.D. Post author

      Since when do you have your thyroid problem? What pills did you take? Any symptoms, presently?

  3. Anonymous

    Hi Doctor, what does “enlarged heterogeneous thyroid with lobulated contour but no discrete module” mean?
    right lobe: 2.1×2.1×5.7 cm
    left lobe: 1.9×2.1×5.8
    isthmus 0.4 cm
    I take levothyroxine 75 mcg
    Thank you!

    1. Buddy M.D. Post author

      Suggests a generalized thyroid disease. If a discrete nodule is found, it is investigated further separately to see if it is malignant or not.

      Generalized enlargements usually happen when the thyroid has to work more to produce its hormone. Hypothyroid states.

  4. Rylan McDaniel

    Hi, my thyroid levels are below a .1
    They say my right glad is very swollen. I feel like I constantly have to swallow clear my throat
    Right lobe measures 7.3×2.0×3.0cm
    Left lobe measures 5.4×2.4×2.4cm
    Ithmus 0.7cm
    I’m trying to figure out what’s going on

        1. Buddy M.D. Post author

          Levels are very low. You appear to be in a Hyper thyroid state, that is, your body is producing more thyroid hormones than required.

          In such cases, metabolism speed up unnecessary, using all body resources, which soon get exhausted. Patient tends to become thin.

          Condition needs to be reversed at the earliest with medication.

          Also, nature of the lobes needs to be investigated. Was a biopsy done? If yes, can you share the report here.

  5. Sanne

    Recent ultrasound result:

    Right lobe measures 4.5 x 1.8 x 1.6cm and the left lobe measures 3.8 x 1.2 x 1.5cm isthmus measures 4mm

    The glad is heterogeneous and hyperemic. The boarders are somewhat lobular. There are no well-defined nodules noted.

    Heterogeneous thyroid with increased vascularity and lobular boarders suggestive of thyroiditis. Clinical correlation is recommended.

    I am on levothyroxine 50mg

    Current symptoms:
    Super dry skin
    Severe constipation
    Cold all the time
    Right side neck pain
    Struggling with depression
    resting heart rate at 96
    TSH is in mid range “normal”


    I don’t feel much better on the medication and the pain in my neck has not gone away I’ve had it for 4 months now. What else can I do?

    1. Buddy M.D. Post author

      Is this the only medication you are taking? what is your exact diagnosis, is it Hashimoto?

      1. Sanne

        I have not been given an exact diagnosis. They are just treating the low TSH with that one med. I was put on Effexor for anxiety and depression 150mg and Trazondone 150mg for insomnia as well. I began to get severe panic attacks shortly before I was diagnosed with Hypothyroidism. The Levothyroxine helped with the panic attacks and hand tremors I was having. I still have hand tremors some of the time. I am only being seen by a general practitioner. Should I be seeing an endocrinologist?

  6. Stuart Lucado

    Hi Doctor,

    My Thyroid ultrasound result stated a nontoxic single nodule. There is a dominant multilobulated nodule replacing the majority of the left thyroid lobe measuring 62 x 28 x 31 mm with a 12 x 5 x 10 mm central course calcification noted. The thyroid parenchyma is heterogenous in echotexture with lobulated

    I am having difficulty determining what this means. My ENT has set up a fine needle biopsy for me but I am worried about what the US results are telling him.

    Male/33 who has not had any major health problems.

    1. Buddy M.D. Post author

      Likely to be non cancerous.

      We’ll have to wait for the biopsy for exact diagnosis. Do share the follow up here.

      1. Stuart Lucado

        Well that helps. I went reading on google and read that when there is calcification in a single module that the malignancy rate is 75% and it freaked me out. I would assume there are other circumstances and that it might not be so cut and dry but it scared me deeply.

        I don’t know what any of those findings mean but google scared me to death.

        My biopsy is in 2 days so hopefully I have an update real soon to give you.

        Thanks for the quick reply.

          1. Stuart Lucado

            Got my results back. Unfortunately, it did test positive for papillary cancer. It did spread to at least one lymph node but my ENT is great and the hospital is fantastic. So he is confident that this can be cured and I can move on with my life.

  7. Houston Diva

    I have been borderline low thyroid for over 5 years. I have been treated by a holistic ob/gyn for years who had me go gluten and corn free and take several supplements daily, exercise, and decrease stress and adrenal fatigue. These measures eliminated several symptoms such as brain fog, fatigue, heavy menstrul cycles, irregular cycles, etc. Bloodwork recently showed high iodine levels, so a thyroid US was ordered. The diagnosis appears to be lobular heterogeneois thyroid. Right lobe: 5.6 x 1.7 x 1.8 vol 8.2 & left lobe: 3.9 x 1.4 x 1.7 vol -4.5. What is usually the next step?

  8. Karen H

    I have had hypothyroidism for 25+ years and was on levothyroxine .112mcg for years. All of a sudden my levels are sitting at zero for a year. I’ve gradually gratuated up to 200mcg and decreased down to currently on 125mcg. Last check 0. Im physically a mess. I had an ultrasound 3 weeks ago. The results say Heterogeneous echotexture w lobulate boarders suggesting chronic thyroiditis. What does this mean?

  9. Eryn

    I just got my ultrasound results back and my PCP has referred me to an ENT urgently. The results are confusing to me. I went to the doctor dor something else and she found an inflamed lymph node and started me on antibiotics for that and the other reason for my visit. I followed up 2 weeks later and she said she wanted an ultrasound of that lymph node and my thyroid because it was enlarged.
    The results were
    For thyroid: the isthmus measures 3mm. Right lobe measures 45×14×14mm and the left lobe 43×16×13mm. There is mild degree of heterogeneity of the gland without focal contour deforming mass.
    Color dopler interrogation did not differential abnormality

    Neck lymph node:
    Survey of the right neck soft tissues of clinically palpable complaint wes performed. At this location at the upper lateral aspect of the right neck soft tissue is a 18×16×6mm lymph node with preserved fatty hilum. Color doppler interrogation did not demonstrate any differential abnormality. No othe cystor solid lesio. Identified.

    My TSH level is 1.86 and have had hoarseness and difficulty swallowing for a couple of months.
    What does this mean and what could this mean?
    Thank you

      1. Buddy M.D. Post author

        You may be called for a biopsy from your thyroid gland. Your doctor, perhaps, wishes to rule out malignancy.

  10. Eryn

    My question though is is my thyroid inlarg’d with a mass or is there no mass? That’s the hard part for me to understand

  11. Carla Thomas

    This is my recent ultrasound results. What does all this mean. I am having a FNA done on the 15th.


    Right lobe:
    The right lobe measures 5.3 x 1.7 x 2.4 cm. It is multinodular. There is a
    echogenic 7.7 x 5.4 x 5.7 mm nodule in the upper pole. In the lower pole.
    There is a dominant 10.2 x 8 x 9.2 mm nodule. Smaller nodules are seen.

    Left Lobe:

    The left lobe measures 4.9 x 1.8 x 2.5 cm. It is multinodular. There is a
    solid 10.5 x 6.5 x 7.4 mm mildly lobulated nodule..

    The isthmus measures 3.9 mm.

    Other Findings:
    Dominant nodules are seen bilaterally. Biopsy is recommended..

    1. Buddy M.D. Post author

      Your gland appears to be having many scattered nodules. Such conditions are usually non cancerous. What are your symptoms that led you to get the scan done?

      Anyway, the exact diagnosis about what those nodules are can be made only after biopsy.

  12. AJITHA

    Hai, Dr I am Aji 45 years old tested pleural effusion 2 days ago and fluid of about 2 l is removed and sent for further investigation the report says my primary cause of malignancy was not ovary breast, or lung cancer .
    when I done USG of thyroid gland this was the report
    diffuse thyromegaly with normal echotexture and increased vascularity ,
    irregular shaped heterogeneously hyperechoic solid nodule with lobulated margins mesuring 3.3*2*2.4 cm is seen in left lobe with internal vascularity.
    oval hypoechoic nodule measuring 3*2 mm seen in isthmus
    DO I have papillary malignancy or cancer in thyroid gland

    1. Buddy M.D. Post author

      This can be confirmed only after your biopsy report.

      Biopsy is taking a tiny part of the tissue and directly examining it under the microscope.

      However, from your radiological description, it does appear to be a malignancy, papillary form.


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