Pinnacle Health System



THYROID ULTRASOUND WORKSHEET

[pic]

Nodules:

Size Location Appearance

| x x cm | | |

| x x cm | | |

| x x cm | | |

| x x cm | | |

□ Multiple additional smaller nodules are present

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

-----------------------

Name:____________________________________________ Date:_____/_____/____ ID:_________________

DOB: _____/______/______ Age:______ Sex: M / F Referring Physician:_________________________

Indications:__________________________________________________________________ Tech:_________

Height: _____________ Weight:______________

Right Lobe: ______ X_____ X_____ cm

( Enlarged ( Heterogeneous ( Increased Vascularity ( Nodules (see chart)

Left Lobe: ______ X_____ X_____ cm

( Enlarged ( Heterogeneous ( Increased Vascularity ( Nodules (see chart)

Isthmus:_______cm

( Enlarged ( Heterogeneous ( Increased Vascularity ( Nodules (see chart)

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