Thyroid ultrasound is a useful diagnostic tool for thyroid nodules and suspicious growths. However, the diagnosis and treatment of nodules and cancer is complex and is not our focus here.
Ultrasound has a practical use in therapy. It can enable a doctor to understand the degree to which the patient’s gland has suffered destruction from autoimmune attack and to what degree it is still capable of producing endogenous T4 and T3 hormone in response to TSH secretion. This knowledge can inform the doctor’s interpretation of blood tests and adjustment of therapy types. To the degree that thyroid follicular cells are lost via atrophy or fibrosis, the patient is less capable of converting T4 into T3 via the “TSH-T3 shunt,” which has recently been theorized and which would explain increasingly low T3:T4 ratio as thyroid gland size, presence, and function decreases. 
In Hashimoto’s thyroiditis, the gland may be either inflamed or diminished in size. Ultrasound can detect the telltale “coarse, heterogeneous and hypoechoic parenchymal echo pattern” as well as “multiple discrete hypoechoic micronodules,” and thus determine the degree to which the gland has fibrosed. [169, 170] An inflamed gland, whether from autoimmune attack or from other causes, has been associated with glucose metabolism disorders, as well as smoking, iodine status, and polycystic ovarian syndrome (PCOS). 
A significantly shrunken gland is a diagnostic sign of the effects of TSH-receptor blocking antibody activity in the past. It was once called “Ord’s disease.” It is not merely a finding in “late-stage Hashimoto’s” as many researchers have thought due to being unaware of this antibody’s unique effects.
The atrophic gland is significantly smaller than a healthy adult male or female gland, may be irregular in shape and fibrosed. Measurements of length, width, and height of each lobe and the isthmus are usually included in ultrasound results if the technician finds the gland size or shape unusual. This enables the doctor to mathematically calculate gland volume by means of the standard ellipsoid formula and compare it with the range of normal thyroid gland size in adult females and males. Atrophied glands are associated with a higher rate of cancers, although they are relatively more benign. 
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