Thyroid Cancer In Hot Nodules

  • Introduction: Hyperfunctioning thyroid nodules are considered benign and according to current guidelines don´t need a biopsy. We describe two cases of hot nodules harbouring thyroid cancer.
    Case 1 : 63 year-old female, with a 5×2.7cm left thyroid nodule and supressed TSH levels. The 99mTC-scintigraphy revealed a single hyperfunctioning nodule with inhibition of the remaining thyroid. Left hemithyroidectomy was performed. Histopathology showed a 4.4cm minimally-invasive follicular thyroid cancer (pT3NxR0). Completion thyroidectomy was done before radiodine ablation therapy. An additional papillary thyroid microcarcinoma (PTMC) was also identified.
    Case 2: 81 year-old male with hyperthyroidism, bilateral thyroid nodules (the largest with 5.5cm on the left lobe and 1.8cm on the right lobe). 131I Scintigraphy showed a left hyperfunctioning nodule with 24-hour uptake of 47%. Total thyroidectomy was done. Histopathology showed follicular variant  papillary thyroid cancer  in two nodules, one with 5cm and angioinvasion on the left lobe and the other with 1.2 cm on the right and two PTMCs, 0.3cm on the right, 0.4cm on the isthmus (pT3aNxR0).
    Conclusion: Rare cases of thyroid cancer in hot nodules exist and the majority are follicular carcinomas (FTC). If a carcinoma is diagnosed at a hot nodule it should be managed according to the current guidelines for classical thyroid carcinomas.


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