title: Follicular variant of papillary thyroid carcinoma presenting as a toxic nodule by I-123 scintigraphy.
abstract: The risk of malignancy in a "hot" thyroid nodule detected by radioiodine scintigraphy is rare. We report a case of a 63-year-old man with a hyperfunctioning nodule demonstrated by radioiodine scintigraphy and cytology suspicious for follicular variant of papillary thyroid carcinoma (FVPTC). There were no locoregional or distant metastases at initial diagnosis. Histopathologic examination following thyroidectomy confirmed the presence of an encapsulated FVPTC. A year into follow-up, his I-131 whole body scan performed following the withdrawal from exogenous thyroid hormone was negative, whereas his serum thyroglobulin (Tg) levels were intermediate. A subsequent PET/CT scan revealed a small, but stable, metabolically active pretracheal lymph node, which on biopsy was confirmed to be stage III FVPTC. In conclusion, the presence of hyperfunctioning thyroid nodule(s) does not preclude malignancy and, therefore, proper cytohistologic evaluation in such patients may help to exclude a coexistent thyroid carcinoma. Patients treated for localized PTC may benefit from serial PET/CT follow-up in the early detection and management of recurrence or distant metastases.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY, USA. sbommirei@chpnet.org
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bommireddipalli
authors.forename: Sumina
authors.initials: S
authors.lastname: Goel
authors.forename: Ramesh
authors.initials: R
authors.lastname: Gadiraju
authors.forename: Alberto
authors.initials: A
authors.lastname: Paniz-MondolFi
authors.forename: Ernest Gordon
authors.initials: EG
authors.lastname: DePuey
mesh_terms: D002277:Carcinoma; D002291:Carcinoma, Papillary; D018265:Carcinoma, Papillary, Follicular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D007457:Iodine Radioisotopes; D019788:Fluorodeoxyglucose F18