Case Author(s): Jeff Chesnut, D.O. and Henry D. Royal, M.D. , 7/26/99 . Rating: #D1, #Q4

Diagnosis: Autonomous functioning toxic thyroid nodule

Brief history:

30 year old female with hyperthyoroidism and palpable left neck nodule.


Anterior image from a Tc-99m pertechnetate thyroid scan is shown.

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View second image(tr). Magnified view of the thyroid is shown.

Full history/Diagnosis is available below

Diagnosis: Autonomous functioning toxic thyroid nodule

Full history:

30 year old female internal medicine resident with hyperthyroidism and large right neck nodule to palpation.


Tc-99m pertechnetate


There is intense activity in a single large nodule in the right neck with suppresion of the remainder of the thyroid gland.


Patients with solitary toxic nodules are often younger than patients with multinodular toxic goiters. They are slightly more common in men, as opposed to multinodular goiters in which sex prediliction is roughly equal.

In young people, surgery is often the treatment of choice for solitary hyperfunctioning nodules, though radioiodine or percutaneous intranodular injection of ethanol may also be used. I-131 therapy is used, however, higher doses of radioiodine are required (15-25 mCi) as these nodules are relatively radioiodine insensitive.


The patient elected not to have surgery on this nodule. She was subsequently treated with 15 mCi radioiodine.

Major teaching point(s):

1. Solitary hyperfunctioning nodules are most common in adolescents or young adults with a slight male prediliction. This is in contrast to multinodular toxic goiters which more often occur in older adults and have no defininte sexual prediliction.

2. If the patient with solitary hyperfunctioning nodule is treated with radioiodine, higher doses are required.

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: tr009

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