Hyperfunctioning Thyroid Nodules: Is there a case for routine biopsy?

    Investigations for patients with hyperthyroidism include positron emission tomography (PET) to identify thyroid nodules. The nodules can be classed as either hyperfunctioning (“hot”), isofunctioning (“warm”) or non-functioning (“cold”), in relation to the tracer uptake on PET scan. The American Thyroid Association states that these nodules need not have cytological evaluation, as they rarely harbour malignant tissue.

    We present two cases of patients with “hot” thyroid nodules on positron emission tomography that were subsequently discovered to be to be papillary thyroid cancers. The first was a patient with a hyperfunctioning nodule <2cm. Biopsy of the nodule gave us the diagnosis and she underwent curative surgery. The second patient had a TSH level <0.1 and was found to have a papillary thyroid cancer with lateral cervical lymph node metastases. We have then reviewed some of the recent literature pertaining to this topic and discuss whether there is an argument for introducing cytological evaluation as part of our routine practice

    Clinicians must be aware of the malignant possibility of a “hot” thyroid nodule during investigations of the hyperthyroid patient.


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