Presentation
Patient with known history of multinodular goiter, follow-up of multiple thyroid nodules and functional assessment.
Patient Data
There are multiple nodules (7 entirely characterized on the scan but not all are shown above) throughout the right and left lobe of the thyroid gland, ranging from TIRADS 0 to TIRADS 5.
The TIRADS 5 lesion annotated above measures 10 x 8 x 8 mm, is solid, hypoechoic with smooth margins, and small punctate calcifications and is not taller than wide.
The isthmus of the thyroid measures 5mm in thickness.
There is also increased vascularity within both lobes of the thyroid, the right more than the left.
The thyroid gland is entirely suprasternal, with the right lobe being larger than the left.
There is heterogenous uptake within both lobes of the thyroid with multiple areas of increased uptake in the right lobe, particularly in the mid-lower zone.
There is generally increased overall uptake in the thyroid gland with a neck-to-thigh ratio of 20.3
Case Discussion
Overall findings are consistent with toxic multinodular goiter. Given the increased activity within multiple nodules as seen on the nuclear medicine scan, the diagnosis of toxic multinodular goiter can be made.
Before these follow-up scans, the patient received a fine-needle aspirate biopsy per ACR TI-RADS guidelines confirming benign colloid nodules.
This patient went on to receive I-131 thyrotoxicosis therapy with good symptom relief.
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