Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism

Sung Hye Kong; Seo Young Lee; Ye Seul Yang; Jae Hoon Moon

doi:10.11106/ijt.2016.9.1.47

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Kong, Lee, Yang, and Moon: Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism

Case Report

Int J Thyroidol 2016;9(1):47-50.

Published online: 20 May 2016

DOI: https://doi.org/10.11106/ijt.2016.9.1.47

Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism

Sung Hye Kong, Seo Young Lee, Ye Seul Yang, 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, E-mail: jaemoon76@gmail.com

Received 4 May 2016 Revised 11 May 2016 Accepted 12 May 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.^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 which⁹9m Tc single photon emission was identical with the hyperfunctioning nodule confirmed in thyroid scan by 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

References

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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.

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).

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