Journal List > Int J Thyroidol > v.9(1) > 1082755

Int J Thyroidol. 2016 May;9(1):47-50. Korean.
Published online May 31, 2016.  https://doi.org/10.11106/ijt.2016.9.1.47
Copyright © 2016. the Korean Thyroid Association. All rights reserved.
Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism
Sung Hye Kong, Seo Young Lee, Ye Seul Yang and Jae Hoon Moon
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence: Jae Hoon Moon, MD, PhD, Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 13620, Korea. Tel: 82-31-787-7068, Fax: 82-31-787-4052, Email: jaemoon76@gmail.com
Received May 04, 2016; Revised May 11, 2016; Accepted May 12, 2016.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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. 99mTc 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 99mTc 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.

Keywords: Hyperfunctioning nodule; Thyroid cancer; Radionuclide imaging; Ultrasonography

Figures


Fig. 1
Thyroid s can (A), 99mTc SPECT/CT (B), and CT scan (C) showed about 2 cm sized hot nodule in upper pole of right lobe (99mTcO4 uptake: 3.3%). SPECT/CT: single photon emission computed tomography/computed tomography.
Click for larger image


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.
Click for larger image


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 observed including pale chromatin, pseudoinclusions, and nuclear grooves (×400).
Click for larger image

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