Follicular variant of papillary thyroid carcinoma presenting as a toxic nodule by I-123 scintigraphy

Srinivas Bommireddipalli, Sumina Goel, Ramesh Gadiraju, Alberto Paniz-Mondolfi, Ernest Gordon Depuey

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


The risk of malignancy in a "hot" thyroid nodule detected by radioiodine scintigraphy is rare. We report a case of a 63-year-old man with a hyperfunctioning nodule demonstrated by radioiodine scintigraphy and cytology suspicious for follicular variant of papillary thyroid carcinoma (FVPTC). There were no locoregional or distant metastases at initial diagnosis. Histopathologic examination following thyroidectomy confirmed the presence of an encapsulated FVPTC. A year into follow-up, his I-131 whole body scan performed following the withdrawal from exogenous thyroid hormone was negative, whereas his serum thyroglobulin (Tg) levels were intermediate. A subsequent PET/CT scan revealed a small, but stable, metabolically active pretracheal lymph node, which on biopsy was confirmed to be stage III FVPTC. In conclusion, the presence of hyperfunctioning thyroid nodule(s) does not preclude malignancy and, therefore, proper cytohistologic evaluation in such patients may help to exclude a coexistent thyroid carcinoma. Patients treated for localized PTC may benefit from serial PET/CT follow-up in the early detection and management of recurrence or distant metastases.

Original languageEnglish
Pages (from-to)770-775
Number of pages6
JournalClinical Nuclear Medicine
Issue number10
StatePublished - Oct 2010
Externally publishedYes


  • I-123 scintigraphy
  • PET/CT imaging
  • follicular variant of papillary thyroid carcinoma
  • hot nodule
  • toxic nodule


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