Case Author(s): Samuel Wang, M.D. and Keith Fischer, M.D. , 9/22/96 . Rating: #D2, #Q3

Diagnosis: Hyperfunctioning thyroid adenoma

Brief history:

16-year old female patient with increasingly difficult behavior.


Anterior images of the neck.

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Full history/Diagnosis is available below

Diagnosis: Hyperfunctioning thyroid adenoma

Full history:

This is a 16-year old white female patient who over the last year has been noted by her family to have increasingly difficult behavior with poor impulse control, worsening relationships with family members, and temper tantrums. Psychiatric evaluation performed one month prior to this study suggested a bipolar disorder. Two weeks prior to this study, lithium carbonate treatment was instituted. Subsequently, the patient brought a thyroid nodule to the attention of the psychiatrist. Thyroid function tests done at the time of this study demonstrated total serum thyroxine of 9.8 (4.5-12.5 ug/dl), a T3 resin uptake of 34 (22-35%), and a serum TSH of less than 0.1 (0.4-5.5 uIU/mL). Physical examination demonstrated a 4 x 2 cm oblong smooth nodule in the left lobe of the thyroid gland.


Tc-99m pertechnetate i.v.


Thyroid scintigraphy with Tc- 99m pertechnetate demonstrates intense uptake of the radiopharmaceutical corresponding to the palpable nodule in the left lobe of the thyroid. There is also suppression of uptake in the remainder of the left lobe as well as the entire right lobe.


The scintigraphic findings in conjunction with the patient's history and elevated thyroid function tests are most consistent with an autonomous toxic nodule. Surgical resection was performed, which demonstrated follicular adenoma.

ACR Codes and Keywords:

References and General Discussion of Thyroid Scintigraphy (Anatomic field:Face, Mastoids, and Neck, Category:Metabolic, endocrine, toxic)

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Case number: tr005

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