Single cold nodule in Graves' disease: benign vs malignant Poster No.: C-0073 Congress: ECR 2011 Type: Authors: Keywords: DOI: Scientific Paper L. I. Sonoda, M. Halim, K. Balan; Cambridge/UK Head and neck, Thyroid / Parathyroids, Nuclear medicine conventional, Ultrasound, Diagnostic procedure, Biopsy, Neoplasia, Endocrine disorders, Cysts 10.1594/ecr2011/C-0073 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 8
Purpose The presence of solitary cold nodules (CN) in patients with Graves' disease (GD) raises concern about associated malignancy. The purpose of this study was to assess the frequency of scintigraphic cold defects in patients with GD, and to determine the prevalence of thyroid cancer in such patients. Images for this section: Fig. 1: An example of cold nodule in Graves' disease Page 2 of 8
Methods and Materials A retrospective review of 1536 patients who underwent thyroid scintigraphy during a 5-year-period was performed. Of these, patients with biochemical and scintigraphic diagnosis of GD and presence of a solitary CN were selected for further evaluation for cancer, which included: wording in the report, follow-up ultrasound (US), FNA/biopsy and clinical follow-up. Results 697/1536 (45.4%) patients had GD, of whom 43 (6.2%) patients had single CN. 40/43 reports (93%) suggested further evaluation to exclude malignancy. 21(48.8%) patients with CN had an US. 12 patients had FNA/biopsy, of whom 3 (7.0%) patients had thyroid cancer. Of 22 (51.2%) patients with CN who did not have an US, 6 patients did not require it for other reasons. In the remaining 16 (37.2%) patients with CN there was no documented reason for not having an US/FNA/biopsy. No untoward finding however was reported in these patients on 5 year follow-up. Images for this section: Page 3 of 8
Fig. 1: Distribution of the outcomes of the thyroid scintigraphy Page 4 of 8
Fig. 2: Presence of solitary cold nodule in Graves' disease Page 5 of 8
Fig. 3: Location of solitary cold nodule in Graves' disease Page 6 of 8
Fig. 4: Distribution of clinical outcome Page 7 of 8
Conclusion Thyroid scintigraphy is an important preliminary test in the evaluation of patients with GD. The prevalence of thyroid cancer in the location corresponding to a focal cold SC defect provides justification for further diagnostic evaluation or surgical management. The solitary cold lesions associated with GD have to be taken seriously since their potential for malignancy is significant. References Balmes, E; Burcea, A; Belgun, M, et al. Marine-Lenhart syndrome. Case report and literature review. ACTA ENDOCRINOLOGICA-BUCHAREST 2007:3(2):201-208 Cakir, M. Marine-Lenhart syndrome. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION 2005:97(7):1036-1038 Braga-Basaria, M; Basaria, S. Marine-Lenhart syndrome. THYROID 2003:13(10):991-991 Personal Information Dr Luke Ienari SONODA BA MA MB BChir (Cambridge) PhD FRCR luke@sonoda.co.uk Page 8 of 8