Abstract
A 68-year-old woman with solid/trabecular follicular thyroid carcinoma inside of an autonomously functioning thyroid nodule is described in this paper. The patient was referred to our clinic for swelling of the neck and an increased pulse rate. Ultrasonography showed a slightly hypoechoic nodule in the right lobe of the thyroid. Despite suppressed TSH levels, the 99mTc-pertechnetate scan showed a hot area corresponding to the nodule with a suppressed uptake in the remaining thyroid tissue. Histopathological examination of the nodule revealed a solid/trabecular follicular thyroid carcinoma. To the best of our knowledge, this is the first case of hyperfunctioning follicular solid/trabecular carcinoma reported in the literature. Even if a hyperfunctioning thyroid carcinoma is an extremely rare malignancy, careful management is recommended so that a malignancy will not be overlooked in the hot thyroid nodules.
Highlights
Hyperthyroidism due to thyroid carcinoma is an extremely rare phenomenon
Hyperthyroidism due to thyroid carcinoma is a rare, but well-recognized phenomenon. This situation has been generally described as resulting from excessive production of thyroid hormone by extensive functioning metastases, usually from follicular carcinoma [2, 3]
The incidence of thyroid carcinoma in a hot nodule is reported to be very low by most authors [4,5,6], but the incidence is somewhat higher in other retrospective studies [7, 8]
Summary
Hyperthyroidism due to thyroid carcinoma is an extremely rare phenomenon. It is commonly believed that the diagnosis of a solitary autonomously functioning thyroid nodule (AFTN)—a solitary “hot” nodule in radionuclide imaging— can almost always rule out malignancy in the nodule [1]. A 68-year- old female, affected by a long-standing asymptomatic normally functioning nodule in the right lobe of the thyroid, developed symptoms of neck swelling and palpitations. The patient presented a resting pulse rate of 108 and blood pressure of 145/90 mmHg. A large painless, well-defined, hard nodule was palpable in the right lobe of the thyroid; the left lobe was normal, and there were no cervical lymphadenopathies. Thyroid function tests showed elevated free triiodothyronine (fT3) of 7.60 pmol/L (reference range 2.30–6.30 pmol/L) and undetectable thyroid-stimulating hormone (TSH) of 0.006 mIU/L (normal 0.4–4.0 mIU/L). The nodule was considered an AFTN, but radioiodine treatment (that is the first-line treatment for AFTN in our centre) was ruled-out based on the symptoms (i.e., neck swelling) and the volume of the nodule. Right loboisthmectomy was performed (Figure 1(b)) and the histological examination
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
