Int J Thyroidol.  2016 May;9(1):47-50. 10.11106/ijt.2016.9.1.47.

Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism

• Kong SH
• Lee SY
• Yang YS
• Moon JH

• KMID: 2164917
• DOI: http://doi.org/10.11106/ijt.2016.9.1.47

Abstract

We report a case of a 74-year-old woman who was incidentally found to have a single thyroid nodule. Laboratory evaluation showed undetectable serum thyroid stimulating hormone and elevated free thyroxine levels. (99m)Tc thyroid scan showed a hyperfunctioning autonomous nodule in a right lobe of the thyroid. Thyroid ultrasonography showed a 2.2 cm sized nonhomogeneous spiculated nodule with microcalcification, and which was identical with the hyperfunctioning nodule confirmed in thyroid scan by (99m)Tc single photon emission computed tomography/computed tomography. Fine needle aspiration was done, and cytology reported as suspicious of malignancy. The patient underwent total thyroidectomy with central neck dissection, and pathology was consistent with papillary thyroid carcinoma. This case report demonstrates that diagnosis of a hyperfunctioning autonomous thyroid nodule does not preclude the possibility of thyroid cancer. Clinicians should consider further evaluation such as ultrasonography and fine needle aspiration in patients with hyperfunctioning autonomous nodules.

Keyword

Hyperfunctioning nodule; Thyroid cancer; Radionuclide imaging; Ultrasonography

MeSH Terms

Aged
Biopsy, Fine-Needle
Diagnosis
Female
Humans
Hyperthyroidism*
Neck Dissection
Pathology
Radionuclide Imaging
Thyroid Gland*
Thyroid Neoplasms*
Thyroid Nodule
Thyroidectomy
Thyrotropin
Thyroxine
Ultrasonography
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1. Thyroid scan (A), 99m Tc SPECT/CT (B), and CT scan (C) showed about 2 cm sized hot nodule in upper pole of right lobe (99m TcO4 uptake: 3.3%). SPECT/CT: single photon emission com-puted tomography/computed tomography.

• 

  Fig. 2. Transverse (A) and axial (B) view of ultrasonogram of thyroid. The nodule with a spiculated margin in the right upper pole was suspicious for malignancy. It was markedly hypoechoic and had microcalcification.

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  Fig. 3. Histological analyses with hematoxylin and eosin staining. (A) Papillary and follicular features in right lobe tumor (×40). (B) Classic nuclear features of papillary thyroid cancer were ob-served including pale chro-matin, pseudoinclusions, and nuclear grooves (×400).

Reference

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