Skip to main content

Hypothyroid Hashimoto’s thyroiditis with scintigraphic and echo-color Doppler features mimicking autonomous adenoma

Journal of Endocrinological Investigation volume 25, pages 469–472 (2002)Cite this article

Abstract

We investigated a 48-yr-old woman on L-T4 therapy (100 μg/d) for primary autoimmune hypothyroidism, diagnosed 15 yr earlier, presenting a firm oval lump in the right thyroid lobe and symptoms of mild thyrotoxicosis. Free T4, free T3, TSH, anti-thyroperoxidase, anti-TG and anti-thyroid microsomal antibodies were determined. Thyroid US and color flow Doppler sonography (CFDS), 99mTechnetium (99mTc), radioiodine scintis-can and US guided fine needle aspiration cytology (FNAC) were performed. On L-T4 therapy, thyroid function tests showed subclinical hyperthyroidism with high anti-thyroid antibody titers. Thyroid US and CFDS revealed a voluminous hypoechoic hy-pervascularized nodule with increased peak systolic velocity (type III pattern) in the right lobe; the extranodular tissue volume was markedly reduced and hypoechoic. The presence of an autonomous functioning nodule associated to Hashimoto’s thyroiditis (HT) was suspected, L-T4 therapy was temporary withdrawn, and the patient re-evaluated 2 months later. Off L-T4 therapy, thyroid function tests revealed marked primary hypothyroidism, while thyroid US and CFDS were unchanged. 99mTc thyroid scan showed a focal increased uptake corresponding to the nodule in the right lobe with nearly absent uptake in the remaining thyroid tissue. Only a faint, patchy thyroid distribution of 131I was detected by radioiodine scan, and RAIU was very low. Cytological examination by FNAC revealed normal follicular cells and several lymphocytes. The final diagnosis was therefore hypothy-roid HT with pseudo-nodular thyroid tissue of the right lobe. To our knowledge, this is the first report of HT mimicking both scintigraphic and CFDS features of an autonomous functioning nodule.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Boyle J.A., Thomson J.A., Greig W.R., Jackson I.M., Boyle I.T. The thyroid scan in patients with Hashimoto’s disease. Acta Endocrinol. (Copenh.). 1966, 51: 337–340.

    CAS  Google Scholar 

  2. Bialas P., Marks S., Dekker A., Field J.B. Hashimoto’s thy-roiditis presenting as a solitary functioning thyroid nodule. J. Clin. Endocrinol. Metab. 1976, 43: 1365–1369.

    CAS  PubMed  Article  Google Scholar 

  3. Takashima S., Matsuzuka F., Nagareda T., Tomiyama N., Kozuka T. Thyroid nodules associated with Hashimoto thy-roiditis: assessment with US. Radiology 1992, 185: 125–130.

    CAS  PubMed  Google Scholar 

  4. Vitti P., Lampis M., Piga M., et al. Diagnostic usefulness of thyroid ultrasonography in atrophic thyroiditis. J. Clin. Ultrasound 1994, 22: 375–379.

    CAS  PubMed  Article  Google Scholar 

  5. Vitti P., Rago T., Mazzeo S., et al. Thyroid blood flow evaluation by color-flow Doppler sonography distinguishes Graves’ disease from Hashimoto’s thyroiditis. J. Endocrinol. Invest. 1995, 18: 857–861.

    CAS  PubMed  Google Scholar 

  6. Malinsky M., Maunand B., Hinard M., Daninos J.M., Leger F.A., Savoie J.C. Unusual scintigraphic aspects of autoimmune thyroiditis presenting as hot nodule or toxic adenoma. Ann. Endocrinol. (Paris) 1979, 40: 63–64.

    CAS  Google Scholar 

  7. Perez Ortiz J.L., Mazana Rivera M., Potenciano Mora J., Tutor Martinez A., Menendez Lozano A. Hashimoto’s thyroiditis mimicking autonomous thyroid nodule. Med. Clin. (Barc.). 1983, 81: 859–860.

    Google Scholar 

  8. Sulimani R.A., el-Desouki M. Hashimoto’s thyroiditis presenting as hot and cold nodules. Clin. Nucl. Med. 1990, 15: 315–316.

    CAS  PubMed  Article  Google Scholar 

  9. Giammarco V., Mariani S., Romeo M.V. Hashimoto’s thy-roiditis presenting as a “hot nodule”. Minerva Endocrinol. 1993, 18: 37–40.

    CAS  PubMed  Google Scholar 

  10. Yarman S., Mudun A., Alagol F., et al. Scintigraphic varieties in Hashimoto’s thyroiditis and comparison with ul-trasonography. Nucl. Med. Commun. 1997, 18: 951–956.

    CAS  PubMed  Article  Google Scholar 

  11. Shambaugh G.E. 3rd, Quinn J.L., Oyasu R., Freinkel N. Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine. J.A.M.A. 1974, 228: 866–869.

    PubMed  Article  Google Scholar 

  12. Turner J.W., Spencer R.P. Thyroid carcinoma presenting as a pertechnetate “hot” nodule, but without 131I uptake: case report. J. Nucl. Med. 1975, 17: 22–23.

    Google Scholar 

  13. Atkins H.L., Klopper J.F., Lambrecht R., et al. A comparison of 99mTc and 123I in thyroid imaging. J. Nucl. Med. 1972, 13: 411.

    Google Scholar 

  14. Strauss H.W., Hurley P.J., Wagner H.N. Advantages of 99mTc-pertechnetate for thyroid scanning in patients with decreased radioiodide uptake. Radiology 1970, 97: 307–310.

    CAS  PubMed  Google Scholar 

  15. Szonyi G., Bowers P., Allwright S., et al. A comparative study of 99mTc and 131I in thyroid scanning. Eur. J. Nucl. Med. 1982, 7: 444–446.

    CAS  PubMed  Article  Google Scholar 

  16. Kusic Z., Becker D.V., Saenger E.L., et al. Comparison of technetium-99m and iodine-123 imaging of thyroid nodules: correlation with pathologic findings. J. Nucl. Med. 1990, 31: 393–399.

    CAS  PubMed  Google Scholar 

  17. Reschini E., Catania A., Ferrari C., Bergonzi M., Paracchi A., Raineri P. Comparison of pertechnetate and radioiodine thyroid scintiscans in thyroid disease. J. Nucl. Biol. Med. 1993, 37: 12–17.

    CAS  PubMed  Google Scholar 

  18. Clark K.J., Cronan J.J., Scola F.H. Color Doppler sonog-raphy: anatomic and physiologic assessment of the thyroid. J. Clin. Ultrasound 1995, 23: 215–223.

    CAS  PubMed  Article  Google Scholar 

  19. Becker D., Bair H.J., Becker W., et al. Thyroid autonomy with color-coded image-directed Doppler sonography: internal hypervascularization for the recognition of autonomous adenomas. J. Clin. Ultrasound 1997, 25: 63–69.

    CAS  PubMed  Article  Google Scholar 

  20. Bogazzi F., Bartalena L., Brogioni S., et al. Thyroid vascu-larity and blood flow are not dependent on serum thyroid hormone levels: studies in vivo by color flow Doppler sonography. Eur. J. Endocrinol. 1999, 140: 452–456.

    CAS  PubMed  Article  Google Scholar 

  21. Boi F., Loy M., Piga M., Serra A., Atzeni F., Mariotti S. The usefulness of conventional and echo color Doppler sonog-raphy in the differential diagnosis of toxic multinodular goiters. Eur. J. Endocrinol. 2000, 143: 339–346.

    CAS  PubMed  Article  Google Scholar 

  22. Ralls P.W., Mayekawa D.S., Lee K.P., et al. Color-flow Doppler sonography in Graves disease: “thyroid inferno”. Am. J. Roentgenol. 1988, 150: 781–784.

    CAS  Article  Google Scholar 

  23. Summaria V., Salvatori M., Rufini V., Mirk P., Garganese M.C., Romani M. Diagnostic imaging in thyrotoxicosis. Rays 1999, 24: 273–300.

    CAS  PubMed  Google Scholar 

  24. Chiovato L., Vitti P., Santini F., et al. Incidence of antibodies blocking thyrotropin effect in vitro in patients with eu-thyroid or hypothyroid autoimmune thyroiditis. J. Clin. Endocrinol. Metab. 1990, 71: 40–45.

    CAS  PubMed  Article  Google Scholar 

  25. Hayashi N., Tamaki N., Konishi J., et al. Sonography of Hashimoto’s thyroiditis. J. Clin. Ultrasound 1986, 14: 123–126.

    CAS  PubMed  Article  Google Scholar 

  26. Gutekunst R., Hafermann W., Mansky T., Scriba P.C. Ultrasonography related to clinical and laboratory findings in lymphocytic thyroiditis. Acta Endocrinol. (Copenh.). 1989, 121: 129–135.

    CAS  Google Scholar 

  27. Nordmeyer J.P., Shafeh T.A., Heckmann C. Thyroid sonog-raphy in autoimmune thyroiditis. A prospective study on 123 patients. Acta Endocrinol. (Copenh.). 1990, 122: 391–395.

    CAS  Google Scholar 

  28. Marcocci C., Vitti P., Cetani F., Catalano F., Concetti R., Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. J. Clin. Endocrinol. Metab. 1991, 72: 209–213.

    CAS  PubMed  Article  Google Scholar 

  29. Sostre S., Reyes M.M. Sonographic diagnosis and grading of Hashimoto’s thyroiditis. J. Endocrinol. Invest. 1991, 14: 115–121.

    CAS  PubMed  Google Scholar 

  30. Pedersen O.M., Aardal N.P., Larssen T.B., Varhaug J.E., Myking O., Vik-Mo H. The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 2000, 10: 251–259.

    CAS  PubMed  Article  Google Scholar 

  31. Miyakawa M., Tsushima T., Onoda N., et al. Thyroid ultra-sonography related to clinical and laboratory findings in patients with silent thyroiditis. J. Endocrinol. Invest. 1992, 15: 289–295.

    CAS  PubMed  Google Scholar 

  32. Oertel Y.C., Oertel J.E. Diagnosis of benign thyroid lesions: fine-needle aspiration and histopathologic correlation. Ann. Diagn. Pathol. 1998, 2: 250–263.

    CAS  PubMed  Article  Google Scholar 

  33. Garcia Mayor R.V., Mendez L.F.P., Paramo C., et al. Fine-needle aspiration biopsy of thyroid nodules: impact on clinical practice. J. Endocrinol. Invest. 1997, 20: 482–487

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Cattedra di Endocrinologia, Endocrinology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy

    F. Boi &  S. Mariotti

  2. Nuclear Medicine, Department of Medical Sciences, University of Cagliari, Cagliari, Italy

    M. Piga

  3. Ultrasonography Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy

    M. Loy

Authors
  1. F. Boi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Piga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Loy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Mariotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Mariotti.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Boi, F., Piga, M., Loy, M. et al. Hypothyroid Hashimoto’s thyroiditis with scintigraphic and echo-color Doppler features mimicking autonomous adenoma. J Endocrinol Invest 25, 469–472 (2002). https://doi.org/10.1007/BF03344040

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03344040

Key-words

  • Autonomous thyroid nodule
  • thyroid scan
  • thyroid color flow Doppler sonography
  • hypothyroidism
  • Hashimoto’s thyroiditis