Clinical Significance of a Solitary Cold Thyroid Nodule in the Setting of Graves Disease

Abstract 123I-NaI thyroid uptake and scan in a 46-year-old woman with symptomatic hyperthyroidism demonstrated marked, diffusely increased uptake consistent with Graves disease, as well as a solitary hypofunctioning ("cold") nodule. Pathologic evaluation following total thyroidectomy and selective neck dissection revealed invasive multifocal papillary thyroid carcinoma in a background of Graves disease and 5 of 36 lymph nodes positive for metastatic disease. This case serves as a reminder that when present a cold nodule in the setting of Graves disease warrants further evaluation for underlying malignancy. Received for publication August 18, 2017; revision accepted October 26, 2017. Conflicts of interest and sources of funding: none declared. Correspondence to: Dwight M. Achong, MD, Nuclear Medicine (115), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612. E-mail: dwight.achong@va.gov. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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