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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