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Case Study: Link Between Hyperfunctioning Thyroid Nodule and Papillary Thyroid Carcinoma

By: Justine Landin, PhD
Posted: Friday, September 18, 2020

Hyperfunctioning benign thyroid nodules may develop into papillary thyroid carcinoma in some patients diagnosed with subclinical hyperthyroidism, according to a case report published in the Journal of Investigative Medicine High Impact Case Reports. This case study indicates that patients with such thyroid nodules should be monitored more closely following the initial evaluation.

“This case serves as a multifaceted reminder that a diagnosis of autonomously functioning thyroid nodules should not be the end of the patient’s evaluation, as we now know, more and more, that it can be a risk factor for tumorigenesis,” reported Gliceida Maria Galarza Fortuna, MD, and colleagues from Mount Sinai Medical Center, Miami Beach.

The patient was a 31-year-old woman who experienced palpitations, fatigue, and night sweats for 1 month prior to examination. A thyroid ultrasound revealed a mixed cystic/solid vascular nodule, which was biopsied via fine-needle aspiration. Cytologic examination of the nodule revealed it was benign (Bethesda II). She was diagnosed with subclinical hyperthyroidism, and subsequent treatment was limited to annual testing.

Four years following the initial examination, the patient exhibited compressive symptoms. This led to multiple fine-needle aspirations of the thyroid nodule, which now resembled a Bethesda III–atypia of undetermined significance nodule. Although a reflex thyroid genomic classifier indicated a low probability of cancer, the patient underwent hemithyroidectomy, which revealed classic papillary thyroid carcinoma with calcifications and cystic change in the nodule. “Even with negative molecular test results, the clinician should consider all the patient risks for thyroid cancer…,” the authors stated.

Disclosure: The study authors reported no conflicts of interest.  

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