Case Author(s): David A. Hillier, M.D., Ph.D. and Tom R. Miller, M.D., Ph.D. , . Rating: #D3, #Q2
Diagnosis: Probable Plummer's disease
Brief history:
35 year-old woman with symptoms of hyperthyroidism.
Images:
Thyroid scintigraphy
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Thyroid scintigraphy, image 2
Full history/Diagnosis is available below
Diagnosis: Probable Plummer's disease
Full history:
35 year-old woman with symptoms of hyperthyroidism. The thyroid is moderately enlarged and there is asymmetry of the thyroid on palpation with the left lobe markedly enlarged.
Radiopharmaceutical:
Thyroid scintigraphy, 10 mCi Tc-99m pertechnetate, i.v.
Findings:
Thyroid scintigraphy:
- Markedly increased uptake in the entire left thyroid lobe.
- Small right lobe.
Discussion:
There is marked asymmetric uptake with increased uptake in the left lobe of the thyroid in a patient with hyperthyroidism and no prior history of thyroid surgery. These findings are most likely due to Plummer's disease (autonymous hyperfunctioning noduel). Arguing slightly against this is the fact that there is faint right lobe activity.
Differential Diagnosis List
The differential diagnosis includes an autonymous toxic nodule (Plummer's disease), multinodular goiter (the smooth appearance of the left lobe mitigates against this), hypoplasia of the right thyroid lobe (uncommon), Hashimoto’s thyroiditis (which can have variable and asymmetric uptake), subacute thyroiditis, lymphoma, colloid cyst. Graves disease (diffuse toxic goiter) is a systemic disease that affects the thyroid diffusely and would not have this appearance.
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: tr008
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