Hyperfunctioning papillary thyroid carcinoma – a case report and literature review

Abstract

Background

Malignant hyperfunctioning thyroid nodules are rare and more likely to occur in follicular cancer types rather than papillary variants. The authors present a case of a papillary thyroid carcinoma associated with a hyperfunctioning nodule.

Methods

A single adult patient submitted to total thyroidectomy with the presence of thyroid carcinoma within hyperfunctioning nodules was selected. Additionally, brief literature was conducted.

Results

An asymptomatic 58-year-old male was subjected to routine blood analysis and a TSH level of <0.003 mIU/L was found. Ultrasonography revealed a 21 mm solid, hypoechoic, and heterogenous nodule with microcalcifications in the right lobe. A fine needle aspiration guided by ultrasound resulted in a follicular lesion of undetermined significance. A ^99mTc thyroid scintigram was followed and identified a right-sided hyperfunctioning nodule. Another cytology was performed and a papillary thyroid carcinoma was derived as a result. The patient underwent a total thyroidectomy. Postoperative histology confirmed the diagnosis and a tumor-free margin with no vascular or capsular invasions.

Conclusion

Hyperfunctioning malignant nodules are a rare association, although a careful approach should be led since major clinical implications arise. Selective fine needle aspiration in all suspicious ≥1 cm nodules should be considered.

Keywords:

• Thyroid nodule
• hyperthyroidism
• thyroid tumor
• malignant nodule
• hot nodule

Author contributions

Authorship was limited to those who have made a significant contribution to the conception, design, execution, or interpretation of the reported work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

Data is available on request from the authors. The data that support the findings of this study are available from the corresponding author, [JPM], upon reasonable request.