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.
Images:
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.
Radiopharmaceutical:
Tc-99m
pertechnetate i.v.
Findings:
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.
Discussion:
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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