Presentation
Patient presented with subclinical hyperthyroidism for assessment.
Patient Data
The right lobe of the thyroid gland is enlarged measuring 21 x 23 x 48 mm.
Most of the right lobe of the thyroid contains a large, mixed echogenicity, spongiform nodule measuring 20 x 20 x 32 mm. There is evidence of some internal vascularity but within normal limits.
There is also a small nodule within the left upper lobe of the thyroid gland measuring 11 x 7 mm.
Technetium pertechnetate scan
The thyroid gland is entirely supra-sternal with the right lobe appearing enlarged, the left lobe being normal.
There is a single homogenous focus of increased uptake within the left mid-upper lobe of the right thyroid in comparison to the background.
Case Discussion
Both the ultrasound and nuclear medicine scan point towards a diagnosis of a hyperfunctioning autonomous nodule ("hot" nodule).
If multiple of these nodules are seen, then a diagnosis of multinodular goiter is more likely but in the presence of a single hyperfunctioning nodule, an autonomous functioning nodule diagnosis is favored.
It is worth noting that almost all of hot nodules (>99%) are of benign pathology so often do not require biopsy 1.
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