Endocrine Abstracts

Introduction: Risk of thyroid cancer is 17-32% in cold nodules and <1 % in hot nodules. Hot nodules are usually associated with Thyrotoxicosis. Patients with thyroid carcinoma are usually euthyroid but may be associated with hypothyroidism. We report 3 patients with hyperthyroidism and associated thyroid carcinoma.

Case 1: A 17 years old lady presented with a lump in the neck and examination revealed prominent nodule on the right. TFTs were suggestive of hyperthyroidism and she achieved euthyroidism within 6 weeks of treatment with carbimazole. USS showed U3 right Thyroid nodule along with multiple benign cystic nodules. FNA reported as appearances consistent with thyroid neoplasm. She underwent right thyroid lobectomy and histology confirmed papillary thyroid carcinoma and also hurtle cell adenoma.

Case 2: A 58 years old lady was found to have subclinical hyperthyroidism when she presented with history of feeling generally unwell and significant weight loss. She had no symptoms of hyperthyroidism but examination revealed multinodular goitre with a prominent nodule in the right and USS showed nodules consistent with (U3) and (U4) and FNA was suggestive of follicular lesion. She underwent total thyroidectomy and histology confirmed Multinodular goitre and 2 papillary micro carcinomas (follicular Variant).

Case 3: A 72 who was on levothyroxine for hypothyroidism previously complained of hoarse voice and night sweats and was found to have subclinical hypothyroidism on the blood test. On examination thyroid gland was felt bulky, USS showed multiple nodules and one of them was consistent with U3. FNA is consistent with follicular lesion and she is currently awaiting surgery.

Discussion: Thyroid nodules are present in 75% of population and only about 1-5% are malignant. We present our patients t to highlight the importance of performing USS in women who presents with goitre and associated hyperthyroidism but with a prominent nodule on examination.