, Volume 7, Issue 2, pp 175–179 | Cite as

Autonomously functioning thyroid nodule treated with radioactive iodine and later diagnosed as papillary thyroid cancer

  • Mehmet Uludag
  • Gurkan Yetkin
  • Bulent Citgez
  • Adnan Isgor
  • Tulay Basak
Case report


The malignancy risk is low in hot thyroid nodules verified by scintigraphy. We present a rare case of papillary carcinoma, initially treated as an autonomous hot nodule. Case report. A 36- year old male patient with a hot thyroid nodule and subclinical hyperthyroidism was treated with 10mCi 131I. On admission, both 99mTc and 131I thyroid scintigraphic imaging revealed a hot nodule at the right lobe accompanied by lower uptake in the remaining thyroid tissue. After treatment, there was a progressive increase in the nodule size; a fine needle aspiration biopsy was thus performed which showed findings compatible with papillary thyroid cancer. The patient was referred to our department for further management. Total thyroidectomy with right central neck dissection was performed. The pathologic examination showed that the whole nodule (1.5 cm diameter) was a columnary type papillary thyroid cancer. Conclusion: In the case of a small-sized toxic thyroid nodule, the possiblility of malignancy cannot be totally ruled out. Suspicious hot nodules should be cytologically evaluated before radioactive iodine treatment to determine the existing malignancy risk. Fine needle aspiration biopsy should be performed in all hot thyroid nodules that increase in size after radioactive iodine treatment.

Key words

Autonomous thyroid nodule Hot nodule Papillary thyroid cancer Radioactive iodine theraphy Solitary thyroid nodule 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wong CK, Wheeler MH, 2000 Thyroid nodules: Rational management. World J Surg 24: 934–941.CrossRefPubMedGoogle Scholar
  2. 2.
    Gharib H, 1997 Changing concepts in the diagnosis and management of thyroid nodules. Endocrinol Metab Clin North Am 26: 777–799.CrossRefPubMedGoogle Scholar
  3. 3.
    Erdogan MF, Anil C, Ozer D, Kamel N, Erdoğan G, 2003 Is it useful to routinely biopsy hot nodules in iodine deficient areas? J Endocrinol Invest 26: 128–131.CrossRefPubMedGoogle Scholar
  4. 4.
    Turner JW, Spencer RP, 1976 Thyroid carcinoma presenting as a pertechnetate hot nodule, but without 131I uptake: case report. J Nucl Med 17: 22–23.PubMedGoogle Scholar
  5. 5.
    Appetecchia M, Ducci M, 1998 Hyperfunctioning differentiated thyroid carcinoma. J Endocrinol Invest 21: 189–192.CrossRefPubMedGoogle Scholar
  6. 6.
    Falk SA 1997 Surgical treatment of hyperthyroidism. In: Falk SA (ed) Thyroid Disease, Lippincott-Raven, New York; pp, 319–340.Google Scholar
  7. 7.
    Mizukami Y, Michigishi T, Nonomura A, et al, 1994 Autonomously functioning (hot) nodule of the thyroid gland. A clinical and histopathologic study of 17 cases. Am J Clin Pathol 101: 29–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Niedziela M, Breborowicz D, Trejster E, Korman E, 2002 Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients. J Pediatr Endocrinol Metab 15: 823–830.CrossRefPubMedGoogle Scholar
  9. 9.
    Lupi A, Orsolon P, Cerisara D, Deantoni-Migliorati G, Vianello-Dri A, 2002 “Hot” carcinoma of the thyroid. Case reports and comments on the literature. Minerva Endocrinol 27: 53–57.PubMedGoogle Scholar
  10. 10.
    Ducci M, Appetecchia M, Marzetti A, 1996 Differentiated carcinoma in autonomously functioning thyroid nodule: case report. Acta Otorhinolaryngol Ital 16: 281–285.PubMedGoogle Scholar
  11. 11.
    Majima T, Doi K, Komatsu Y, et al, 2005 Papillary thyroid carcinoma without metastases manifesting as an autonomously functioning thyroid nodule. Endocr J 52: 309–316.CrossRefPubMedGoogle Scholar
  12. 12.
    Paul SJ, Sisson JC, 1990 Thyrotoxicosis caused by thyroid cancer. Endocrinol Metab Clin North Am 19: 593–612.CrossRefPubMedGoogle Scholar
  13. 13.
    O’Brien T, Gharib H, Suman VJ, van Heerden JA, 1992 Treatment of toxic solitary thyroid nodules: surgery versus radioactive iodine. Surgery 112: 1166–1170.PubMedGoogle Scholar
  14. 14.
    Erdogan MF, Küçük NO, Anil C, et al, 2004 Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas. Nucl Med Commun 25: 1083–1087.CrossRefPubMedGoogle Scholar
  15. 15.
    Oz F, Urgancioglu I, Uslu I, Dervisoglu S, Oz B, Kanmaz B, 1994 Cytologic changes induced by 131I in the thyroid glands of patients with hyperthyroidism; results of fine needle aspiration cytology. Cytopathology 5: 154–163.CrossRefPubMedGoogle Scholar
  16. 16.
    Granter SR, Cibas ES, 1997 Cytologic findings in thyroid nodules after 131I treatment of hyperthyroidism. Am J Clin Pathol 107: 20–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Tezelman S, Grossman RF, Siperstein AE, Clark OH, 1994 Radioiodine-associated thyroid cancers. World J Surg 18: 522–528.CrossRefPubMedGoogle Scholar
  18. 18.
    Schlumberger M, De Vathaire F, 1996 131 iodine: medical use. Carcinogenic and genetic effects. Ann Endocrinol (Paris) 57: 166–176.Google Scholar
  19. 19.
    Gharib H, 2004 Changing trends in thyroid practice: understanding nodular thyroid disease. Endocr Pract 10: 31–39.CrossRefPubMedGoogle Scholar
  20. 20.
    Castro MR, Gharib H, 2000 Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med 107: 113–116.CrossRefPubMedGoogle Scholar

Copyright information

© Hellenic Endocrine Society 2008

Authors and Affiliations

  • Mehmet Uludag
    • 1
  • Gurkan Yetkin
    • 1
  • Bulent Citgez
    • 1
  • Adnan Isgor
    • 2
  • Tulay Basak
    • 3
  1. 1.Department of 2nd General Surgery, Sisli Etfal Training and Research HospitalSisliTurkey
  2. 2.Golden Horn University, AksarayTurkey
  3. 3.Department of Pathology, Sisli Etfal Training and Research Hospital, SisliIstanbulTurkey

Personalised recommendations