Endocrine Abstracts

Introduction: Thyroid nodules are common in Hashimoto’s Thyroiditis (HT) patients. They are usually hypo-functioning or "cold" areas on the scan. Presentation as a functioning "nodule" is extremely unusual. Warner reported the first case of Hashimoto’s thyroiditis and hot nodule in 1971. This rare condition has been previously reported in a few cases too. We present a 55-year-old woman with toxic adenoma and Hashimoto’s Thyroiditis with local compressive signs.

Case report: The patient presents in outpatient consultations with difficulty in breathing and swallowing for 3 months and an enlarged thyroid gland. Physical examination: Mild signs of hyperthyroidism. Enlarged thyroid gland. Laboratory tests: TSH 0.019 (0.3-4.5) and Ft3, Ft4 twice the normal values. Anti TPO 208.14 IU/ml (<5.5) Calcitonin = 0.50 (<6.4), Anti TG = 218.5 (<115). WBC = 7.1 k/ul (4 -10.5), Neutrophils = 3.7 k/ul (1.6-7.56), ALT= 28 U/l (<55), AST= 21 U/l (5-34). Thyroid ultrasonography: The entire left lobe had increased dimensions, occupied by a nodule with cystic degeneration inside with dimensions over 60 mm, that displaces the trachea to the right. The right lobe was reduced in size and had bilateral reactive laterocervical lymph nodes. Thyroid Schinti scan with tc99m showed a hot nodule occupying the entire left lobe of the thyroid with a total uptake of 4.6% (0.35-3.65), with inhibition of the right lobe. Ct scan neck with contrast iv, showed: The left lobe of the thyroid with increased dimensions, transformed into a nodular structure with necrotic degeneration inside, and dimensions of 66×62 mm, extending to the jugular fossa with displacement of the trachea to the right and compressing it. It was concluded that the diagnosis was toxic Adenoma with local compressive signs in a patient with Hashimoto’s Thyroiditis. Under treatment with methimazole 1 mg 2×1 tablets for 6 weeks, TSH, Ft4, and Ft3 were within normal range. Because of compressive signs, the patient performed a total thyroidectomy and the biopsy showed: chronic lymphocytic thyroiditis.

Conclusion: Our case confirms that Toxic adenoma can be associated with Hashimoto’s Thyroiditis. Schinti scans with Tc99m help determine the function of nodules and the decision for definitive treatment.