Presentation
Thyrotoxicosis. Palpable node.
Patient Data
Ultrasound depicts a multinodular, enlarged thyroid. The gland is enlarged and exhibits slightly hypo echoic architecture. Color flow imaging reveals spectacular marked hypervascularity, aka "thyroid inferno", including the nodular elements.
No calcifications are present.
No cervical lymphadenopathy is demonstrated (not shown).
Tc-99m pertechnetate thyroid scan demonstrates inhomogeneous, generally increased uptake throughout the gland without clearly distinguishable cold nodules.
The uptake in the structure going upwards from right thyroid lobe was not removed by swallowing a significant amount of water and thus most likely represents increased uptake in a pyramidal lobe (embryonic remnant of thyroglossal duct), an additional finding suggesting general high degree of uptake.
Case Discussion
Blood samples show thyrotoxicosis with positive TRAb.
Ultrasound appearances are those of thyroiditis with "thyroid inferno" in a co-existing multi nodular goiter. Scintigraphic appearances are in keeping with ultrasound findings, depicting inhomogeneous rather than diffuse increased uptake.
Overall, findings are consistent with nodular Graves disease, a.k.a. Marine-Lenhart syndrome.
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