ECEESPE2025 ePoster Presentations Thyroid (198 abstracts)
Autonomous resolution of a toxic thyroid nodule: a case report
Beatriz R Pereira 1 , Joana Aço 2 , Joana Vinhais 1 , David Veríssimo 1 , Catarina Ivo 1 , Ana Cláudia Martins 1 , Dolores Passos 1 , Luís Lopes 1 , Mafalda Marcelino 1 , João Nunes e Silva 1 , Lucília Salgado 2 & João Jácome de Castro 1
1Endocrinology Department, Portuguese Armed Forces Hospital, Lisbon, Portugal; 2Portuguese Institute of Oncology of Lisbon Francisco Gentil, Nuclear Medicine Department, Lisbon, Portugal
JOINT1375
Introduction/Background: Management of toxic autonomous nodules usually involves antithyroid drugs for temporary control, while definitive treatment options include radioiodine therapy or surgery. However, the natural evolution of these nodules remains an area of interest with uncertain aspects to be explored.
Case Report: A 45-year-old female was sent to the endocrine clinic by her general practitioner with complains of neck discomfort. She was clinically euthyroid, presenting a painless thyroid nodule with about 3 cm on the left lobe. Laboratory tests revealed suppressed TSH levels (0.02 µUI/ml) with normal free T4 levels. Further results showed negative thyroid autoantibodies (antithyroid peroxidase, antithyroglobulin and thyrotropin receptor antibodies), negative C-reactive protein and erythrocyte sedimentation rate. Neck ultrasound revealed heterogeneous thyroid tissue, with a mixed solid and cystic nodule measuring 27 × 20 × 14 mm, in the upper part of the left lobe. Thyroid scintigraphy showed high uptake within the nodule with suppression of the surrounding parenchyma, consistent with an autonomous thyroid nodule. Since the patient was clinical euthyroid no medication was prescribed at the time. At re-evaluation, seven weeks after, TSH raised to 7.8 µUI/ml with free T4 at the lower limit of the reference range. After five weeks, TSH level become normal (2.57 µUI/ml). The patient remained clinically euthyroid and thyroid antibodies were persistently negative. An ultrasound was repeated showing a hypervascular, septated nodule with a cystic component measuring 23x16 mm. At that time scintigraphy also was repeated showing a diffuse increase in radionuclide uptake, with a partially hypoactive area corresponding to the previously detected toxic nodule.
Discussion/Conclusions: This case raises intriguing questions regarding the rare case of a spontaneous involution of the toxic autonomous nodule. Throughout this two-month period, the patient exhibited spontaneous thyroid function fluctuations—from hyperthyroidism to hypothyroidism and finally to euthyroidism—always with negative thyroid autoantibodies. Possible mechanisms include functional exhaustion, fibrosis or necrosis. While toxic nodules are typically persistent and require treatment, this case highlights an unusual and spontaneous resolution with both biochemical and imaging correlation. The evolution of this patient’s nodule from autonomous hyperfunction to apparent inactivation without intervention reenforces that, in selected cases, a conservative approach with close monitoring could justified. Further studies are needed to better understand the mechanisms underlying spontaneous resolution of toxic autonomous nodules and to define predictors of this phenomenon.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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